Hassanain M, Tchervenkov J I, Cantarovich M, Metrakos P, Paraskevas S, Keith D, Baran D, Fernandez M, Mangel R, Chaudhury P
Department of Surgery, McGill University, Montreal, Quebec, Canada.
Transplant Proc. 2009 Jan-Feb;41(1):124-6. doi: 10.1016/j.transproceed.2008.10.046.
Because kidneys show remarkable resilience and can recover function, we examined the impact on long-term graft survival in deceased donor renal transplants of both immediate graft function (IGF) and the rate of renal function recovery over the first 3 months after transplantation.
We included all cadaveric renal transplants from 1990 to 2007 (n = 583). Delayed graft function (DGF) was defined as the need for dialysis in the first 7 days posttransplant. Slow graft function (SGF) and IGF were defined by serum creatinine falls of <20% or >20% in the first 24 hours posttransplant respectively. Recovery of renal function was expressed as either the best creatinine clearance (CrCl) in the first 3 months post-renal transplantation (BCrCl-3mos) as calculated using the Cockcroft-Gault formula or as a percentage of actual versus expected value (as calculated from the donors' CrCl at procurement).
There were 140 (23.6%) subjects who received extended criteria donor (ECD) organs. The overall graft survival at 1 and 5 years was 87.8% and 74%, respectively. The 5-year graft survivals for patients with IGF, SGF, and DGF were 85%, 76%, and 54%, respectively (P < .02). ECD kidneys showed twice the DGF rate (49% vs 23%, P < .001). BCrCl-3mos of <30 mL/min displayed a 5-year graft survival of 34%; 30 to 39 mL/min, 72%; 40 to 49 mL/min, 85%; and >50 mL/min, 82% (P < .001). Similarly, a recovery within 90% of expected CrCl in the first 3 months posttransplant correlated with 5-year graft survival of 81%; a recovery of 70% to 90%, with 65%; and a recovery of <70%, with 51% (P < .001).
Early graft function in the first 3 months showed a significant impact on long-term graft survival after deceased donor renal transplantation.
由于肾脏具有显著的恢复能力且能够恢复功能，我们研究了即刻移植肾功能（IGF）以及移植后前3个月肾功能恢复率对已故供体肾移植长期移植存活的影响。
我们纳入了1990年至2007年期间所有的尸体肾移植病例（n = 583）。延迟移植肾功能（DGF）定义为移植后前7天内需要透析。缓慢移植肾功能（SGF）和IGF分别定义为移植后前24小时血清肌酐下降<20%或>20%。肾功能恢复情况通过使用Cockcroft - Gault公式计算的肾移植后前3个月最佳肌酐清除率（CrCl）（BCrCl - 3mos）或实际值与预期值的百分比（根据供体获取时的CrCl计算）来表示。
有140名（23.6%）受试者接受了扩展标准供体（ECD）器官。1年和5年时的总体移植存活率分别为87.8%和74%。IGF、SGF和DGF患者的5年移植存活率分别为85%、76%和54%（P < 0.02）。ECD肾脏的DGF发生率是正常供体肾脏的两倍（49%对23%，P < 0.001）。BCrCl - 3mos <30 mL/min的患者5年移植存活率为34%；30至39 mL/min为72%；40至49 mL/min为85%；>50 mL/min为82%（P < 0.001）。同样，移植后前3个月内CrCl恢复至预期值的90%以内与5年移植存活率81%相关；恢复至70%至90%与65%相关；恢复至<70%与51%相关（P < 0.001）。
移植后前3个月的早期移植肾功能对已故供体肾移植后的长期移植存活有显著影响。
