Shaheen M F, Shaheen F A M, Attar B, Elamin K, Al Hayyan H, Al Sayyari A
King Saud Bin Abdulaziz University for Health Sciences, King Abdulaziz Medical City, Riyadh, Saudi Arabia.
Transplant Proc. 2010 Jan-Feb;42(1):273-6. doi: 10.1016/j.transproceed.2009.12.052.
To study the influence of nonimmunologic factors on the outcome of extended criteria deceased donor (DD) kidney transplants.
This is a retrospective study of DD transplantation carried out from January 1, 2003 to December 31, 2007, to investigate the impact on graft survival and function of donor renal function at retrieval, cold ischemia time (CIT), delayed graft function (DGF), acute rejection episodes (ARE), age, and weight of donors and recipients, transplant center activities, cause of donor death, donor-recipient gender pairing and size of the donating intensive care unit (ICU).
At retrieval, the frequency of donors with a creatinine clearance <60 mL/min, using the Cockcroft-Gault formula, and age >40 years were 31.7% and 32%, respectively. CIT > 24 hours, DGF, and ARE occurred in 27.1%, 33.4%, and 16.5% of cases, respectively. The overall 1- and 5-year graft and patient survival rates were 88% and 79.8% and 96.6% and 92.3%, respectively. The graft function was inferior with occurrences of ARE (P = .0001), DGF (P = .0001), CIT > 20 hours (P = .005), nontraumatic the donor death (P = .022), and donor ICUs bed capacity <20 (P = .03). The odds ratio (OR) for graft loss with DGF, ARE, and donors right kidneys were 7.74 (95% confidence interval [CI] 6-13.4; P = .0001), 4.47 (95% CI, 2.6-7.6; P = .0001) and 1.7 (95% CI, 1-2.8; P = .045), respectively. Graft function was not influenced by donor renal function at retrieval, donor weight, or donor- recipient gender pairings.
CIT and ARE had an impact on both graft survival and function. DGF and cerebrovascular accidents as the cause of donor death negatively affected graft function during follow-up. ICU center experience had a positive impact on graft survival. Patient survival was affected by recipient age >50 years and female to male donation versus other gender pairings. Neither donor age nor acute terminal rise in the donor serum creatinine affected graft function or survival, or patient mortality.
研究非免疫因素对扩大标准已故供体（DD）肾移植结局的影响。
这是一项对2003年1月1日至2007年12月31日期间进行的DD移植的回顾性研究，旨在调查供肾获取时的肾功能、冷缺血时间（CIT）、延迟性移植肾功能不全（DGF）、急性排斥反应发作（ARE）、供体和受体的年龄及体重、移植中心活动、供体死亡原因、供受体性别配对以及供体重症监护病房（ICU）规模对移植物存活和功能的影响。
获取时，根据Cockcroft - Gault公式计算肌酐清除率<60 mL/分钟的供体频率和年龄>40岁的供体频率分别为31.7%和32%。CIT>24小时、DGF和ARE分别发生在27.1%、33.4%和16.5%的病例中。总体1年和5年移植物及患者存活率分别为88%和79.8%以及96.6%和92.3%。ARE（P = .0001）、DGF（P = .0001）、CIT>20小时（P = .005）、非创伤性供体死亡（P = .022）以及供体ICU床位容量<20（P = .03）时移植物功能较差。DGF、ARE以及供体右肾导致移植物丢失的比值比（OR）分别为7.74（95%置信区间[CI] 6 - 13.4；P = .0001）、4.47（95% CI，2.6 - 7.6；P = .0001）和1.7（95% CI，1 - 2.8；P = .045）。移植物功能不受获取时供体肾功能、供体体重或供受体性别配对的影响。
CIT和ARE对移植物存活和功能均有影响。DGF和作为供体死亡原因的脑血管意外对随访期间的移植物功能有负面影响。ICU中心经验对移植物存活有积极影响。患者存活受受体年龄>50岁以及女性供体至男性受体与其他性别配对的影响。供体年龄和供体血清肌酐急性终末期升高均未影响移植物功能或存活，或患者死亡率。
