移植肾功能延迟与活体供肾移植受者移植肾功能丧失相关的死亡风险。

Delayed graft function and the risk of death with graft function in living donor kidney transplant recipients.

机构信息

Division of Nephrology and the Kidney Transplant Program, Toronto General Hospital, University Health Network, Toronto, Ontario, Canada.

出版信息

Am J Kidney Dis. 2010 Nov;56(5):961-70. doi: 10.1053/j.ajkd.2010.06.024. Epub 2010 Sep 25.

DOI:10.1053/j.ajkd.2010.06.024

PMID:20870331

Abstract

BACKGROUND

The link between delayed graft function (DGF) and death with graft function (DWGF) in living donor kidney transplant recipients presently is unknown.

STUDY DESIGN

Retrospective cohort study.

SETTING & PARTICIPANTS: 44,630 adult living donor kidney recipients (first transplants only) in the US Renal Data System from January 1, 1994, to December 31, 2004.

PREDICTOR

DGF, defined as the need for dialysis therapy in the first week after transplant.

OUTCOME

Time to DWGF.

MEASUREMENTS

Kaplan-Meier curves were constructed to assess the impact of DGF on DWGF. Recipients with DGF were 1:1 propensity score matched to those without DGF, and time-dependent Cox proportional hazards models were used to examine factors associated with DWGF. Subgroup and sensitivity analyses also were conducted.

RESULTS

DWGF occurred in 3,878 patients during 3.9 years' (median) follow-up. In patients with DGF, survival with graft function at 1, 3, 5, and 10 years was 91.9%, 86.8%, 81.6%, and 61.7%, respectively (in patients without DGF, these values were 98.0%, 95.2%, 91.6%, and 80.1%, respectively; P < 0.001 compared with the DGF group). In a fully adjusted time-dependent Cox model, HRs for DWGF in patients with DGF (vs without DGF) were 6.55 (95% CI, 4.78-8.97), 3.55 (95% CI, 2.46-5.11), 2.07 (95% CI, 1.53-2.81), and 1.48 (95% CI, 1.26-1.73) at 0-1, 1-3, 3-12, and longer than 12 months posttransplant, respectively. Propensity score analysis showed similar results. Inferences were unchanged after adjustment for kidney function and acute rejection at 6 months and 1 year posttransplant. Cardiovascular and infectious causes of DWGF were more prevalent in patients with DGF. The association was more marked in female recipients and robust to various sensitivity analyses.

LIMITATIONS

The impact of lesser decreases in early graft function could not be evaluated.

CONCLUSIONS

DGF is associated with an increased risk of DWGF in living donor kidney recipients. The mechanisms underlying this relation require further study.

摘要

背景

目前，活体供肾移植受者中延迟移植物功能（DGF）与移植物功能丧失相关死亡（DWGF）之间的联系尚不清楚。

研究设计

回顾性队列研究。

研究地点和参与者

1994 年 1 月 1 日至 2004 年 12 月 31 日，美国肾脏数据系统中 44630 名接受首次活体供肾移植的成年受者。

预测指标

DGF 定义为移植后第 1 周需要透析治疗。

主要结局指标

DWGF 的时间。

测量方法

构建 Kaplan-Meier 曲线以评估 DGF 对 DWGF 的影响。将 DGF 受者与无 DGF 受者按 1:1 进行倾向评分匹配，并使用时间依赖性 Cox 比例风险模型检查与 DWGF 相关的因素。还进行了亚组和敏感性分析。

结果

在 3.9 年（中位数）的随访中，3878 例患者发生 DWGF。在 DGF 患者中，移植后 1、3、5 和 10 年的有功能移植物存活率分别为 91.9%、86.8%、81.6%和 61.7%（无 DGF 患者分别为 98.0%、95.2%、91.6%和 80.1%；与 DGF 组相比，P<0.001）。在完全调整的时间依赖性 Cox 模型中，DGF 患者（与无 DGF 患者相比）发生 DWGF 的 HR 分别为 6.55（95%CI，4.78-8.97）、3.55（95%CI，2.46-5.11）、2.07（95%CI，1.53-2.81）和 1.48（95%CI，1.26-1.73），分别在移植后 0-1、1-3、3-12 和 12 个月以上。倾向评分分析显示出类似的结果。在调整移植后 6 个月和 1 年的肾功能和急性排斥反应后，结果仍然不变。DGF 患者 DWGF 的心血管和感染原因更为常见。这种关联在女性受者中更为明显，并且对各种敏感性分析均稳健。