Department of Nephrology, Royal London Hospital, London, United Kingdom.
Transplantation. 2010 Jan 15;89(1):97-103. doi: 10.1097/TP.0b013e3181be3dd1.
Delayed graft function (DGF) has a major impact on long-term renal transplant survival. However, it is a diagnosis made retrospectively with little opportunity to modify treatment protocols. A classification based on creatinine reduction ratio between days 1 and 2 (CRR2) suggests that patients with CRR2 less than or equal to 30% (nondialysis requiring DGF [ND-DGF]) have similar outcomes to those with dialysis-requiring delayed graft function (D-DGF). We retrospectively applied this definition in our cohort of patients to examine outcomes.
We studied the association between CRR2 and graft outcomes in all 367 patients transplanted between 1996 and 2004 at our center. Patients were divided into the following three groups: IGF (immediate graft function; CRR2 >30%), D-DGF, and ND-DGF. Mean follow-up was 4.2 years.
IGF accounted for 36% of patients, D-DGF for 22%, and ND-DGF for 42%. CRR2 was inversely correlated with serum creatinine on days 7, 30, 90, and 365 (r ranging from -0.65 to -0.22, P<0.001). Graft survival at 5 years was 98% (IGF), 74% (D-DGF), and 89% (ND-DGF). There was a significant difference in graft survival between IGF and D-DGF (P<0.001) and IGF and ND-DGF (P=0.005). In a multivariate analysis adjusting for recipient age and sex, donor age and sex, and human leukocyte antigen mismatch, graft failure was 2.4 times more likely to occur in patients with D-DGF than those with ND-DGF(P=0.02).
Our study shows CRR2 influences long-term graft outcomes. Unlike the original description, patients with ND-DGF carry an intermediate risk and perhaps should be considered on day 2 for alternative treatment protocols.
延迟移植物功能（DGF）对长期肾移植存活率有重大影响。然而，它是一种回溯性诊断，几乎没有机会修改治疗方案。基于第 1 天和第 2 天之间肌酐降低率（CRR2）的分类表明，CRR2 小于或等于 30%（不需要透析的 DGF [ND-DGF]）的患者与需要透析的延迟移植物功能障碍（D-DGF）患者的结局相似。我们回顾性地将这一定义应用于我们的患者队列中，以检查结局。
我们研究了 1996 年至 2004 年在我们中心接受移植的 367 例患者中 CRR2 与移植物结局之间的关系。患者分为以下三组：IGF（立即移植物功能；CRR2>30%）、D-DGF 和 ND-DGF。平均随访 4.2 年。
IGF 占 36%，D-DGF 占 22%，ND-DGF 占 42%。CRR2 与第 7、30、90 和 365 天的血清肌酐呈负相关（r 范围从-0.65 到-0.22，P<0.001）。5 年移植物存活率为 98%（IGF）、74%（D-DGF）和 89%（ND-DGF）。IGF 与 D-DGF 之间（P<0.001）和 IGF 与 ND-DGF 之间（P=0.005）在移植物存活率方面存在显著差异。在调整受者年龄和性别、供者年龄和性别以及人类白细胞抗原错配的多变量分析中，D-DGF 患者发生移植物失败的可能性是 ND-DGF 患者的 2.4 倍（P=0.02）。
我们的研究表明 CRR2 影响长期移植物结局。与原始描述不同，ND-DGF 患者处于中间风险，也许应该在第 2 天考虑替代治疗方案。
