Department of Surgery, Division of Transplantation, University of California-San Francisco, CA, USA.
Am J Transplant. 2010 Feb;10(2):298-303. doi: 10.1111/j.1600-6143.2009.02936.x. Epub 2010 Jan 6.
Early graft function is a major determinant of long-term outcomes after renal transplantation. Recently, recipient diabetes was identified as a risk factor for poor initial graft function in living donor renal transplantation. To further explore this association, we performed a paired analysis of deceased donor renal transplants from January 1994 to December 2005. A total of 25,523 transplant pairs were analyzed via conditional logistic regression. Diabetic recipients were older (53.16 vs. 46.75 years, p < 0.01), had a lower average panel reactive antibody (12% vs. 15%, p < 0.01) and fewer prior transplants (0.07 vs. 0.12, p < 0.01). Recipient diabetes, age, male gender, African American race, elevated peak panel reactive antibody and increased cold ischemia time were independent risk factors for delayed graft function. Specifically, diabetic recipients had increased risk of DGF on univariate analysis (odds ratio [OR] 1.32, 95% confidence interval [CI] 1.23-1.42, p < 0.01). Multivariable analysis confirmed this association but the risk differed by recipient gender; with diabetes having a greater effect in women (OR 1.66, 95% CI 1.45-1.91, p < 0.01) compared to men (OR 1.28, 95% CI 1.15-1.43, p < 0.01). It is unknown whether the deleterious impact of recipient diabetes on graft function after renal transplantation results from perioperative hyperglycemia or the chronic sequelae of diabetes.
早期移植物功能是肾移植后长期预后的主要决定因素。最近，研究发现，受体糖尿病是活体供肾移植中初始移植物功能不良的危险因素。为了进一步探讨这种相关性，我们对 1994 年 1 月至 2005 年 12 月期间的尸肾移植进行了配对分析。通过条件逻辑回归分析了 25523 对移植。糖尿病受者年龄较大（53.16 岁 vs. 46.75 岁，p<0.01），平均群体反应性抗体较低（12% vs. 15%，p<0.01），移植前较少（0.07 次 vs. 0.12 次，p<0.01）。受体糖尿病、年龄、男性、非裔美国人种族、峰值群体反应性抗体升高和冷缺血时间延长是延迟移植物功能的独立危险因素。具体而言，糖尿病受者在单因素分析中延迟移植物功能的风险增加（优势比 [OR] 1.32，95%置信区间 [CI] 1.23-1.42，p<0.01）。多变量分析证实了这种相关性，但风险因受者性别而异；在女性中，糖尿病的影响更大（OR 1.66，95%CI 1.45-1.91，p<0.01），而在男性中则较小（OR 1.28，95%CI 1.15-1.43，p<0.01）。目前尚不清楚受体糖尿病对肾移植后移植物功能的不良影响是源于围手术期高血糖还是糖尿病的慢性后果。
