Department of Nephrology and Transplantation, Renal Institute of Birmingham, University Hospital Birmingham, Birmingham, United Kingdom.
Transplantation. 2010 Nov 27;90(10):1113-6. doi: 10.1097/TP.0b013e3181f86966.
The traditional definition of delayed graft function (DGF) rests on dialysis requirement during the first postoperative week. Subsequently, a more objective and "functional" definition of DGF (fDGF) has been proposed as an alternative to this dialysis-based definition of DGF (dDGF) and defined as a failure of the serum creatinine to decrease by at least 10% daily on 3 successive days during the first week posttransplantation, irrespective of dialysis requirement. However, an association between fDGF and long-term graft failure has not been fully established, and it is unknown whether fDGF is a better marker of subsequent outcomes than dDGF.
We studied 750 adult deceased donor kidney transplant recipients (1996-2006) and analyzed the association between these two DGF definitions and long-term graft outcome.
Univariable associations with death-censored graft failure were seen for both dDGF and fDGF (hazard ratio [HR] 1.59; 95% confidence interval [CI] 1.16-2.18; P=0.004 and HR 1.72; 95% CI 1.26-2.36; P=0.001, respectively). On bivariable analysis (dDGF vs. fDGF), dDGF lost significance, whereas the effect of fDGF persisted (HR 1.52; 95%CI 1.03-2.25; P=0.04). This was also the case in a multivariable model, where fDGF but not dDGF was significantly associated with graft failure (HR 1.47; 95%CI 1.06-2.03; P=0.02). Results were similar for overall graft failure.
This study confirms the utility of fDGF as an early marker of subsequent inferior allograft outcomes, suggesting superiority over the traditional (often subjective) dialysis-based definition. Wider adoption of the fDGF definition should be considered, both as a risk-stratification tool in clinical practice and a clinical trial endpoint.
传统的延迟移植物功能（DGF）定义依赖于术后第一周的透析需求。随后，提出了一种更客观和“功能性”的 DGF 定义（fDGF），作为 DGF（dDGF）基于透析定义的替代，并定义为在移植后第一周的连续 3 天内，血清肌酐每日至少降低 10%，而不论透析需求如何。然而，fDGF 与长期移植物失败之间的关联尚未得到充分确立，并且尚不清楚 fDGF 是否比 dDGF 更能作为随后结局的标志物。
我们研究了 750 例成年尸肾移植受者（1996-2006 年），并分析了这两种 DGF 定义与长期移植物结局之间的关系。
dDGF 和 fDGF 均与死亡校正移植物失败有单变量关联（危险比 [HR] 1.59；95%置信区间 [CI] 1.16-2.18；P=0.004 和 HR 1.72；95%CI 1.26-2.36；P=0.001）。在双变量分析（dDGF 与 fDGF）中，dDGF 失去了意义，而 fDGF 的影响仍然存在（HR 1.52；95%CI 1.03-2.25；P=0.04）。在多变量模型中也是如此，其中 fDGF 而不是 dDGF 与移植物失败显著相关（HR 1.47；95%CI 1.06-2.03；P=0.02）。对于整体移植物失败，结果相似。
本研究证实了 fDGF 作为随后移植后不良结局的早期标志物的实用性，表明其优于传统的（通常是主观的）基于透析的定义。应考虑更广泛地采用 fDGF 定义，既作为临床实践中的风险分层工具，也作为临床试验终点。
