胰肾联合移植后移植肾延迟功能恢复

Delayed kidney allograft function after simultaneous pancreas-kidney transplantation.

作者信息

Rangel E B, Melaragno C S, Gonzalez A M, Linhares M M, de Sá J R, Salzedas A, Medina-Pestana J O

机构信息

Division of Nephrology, Universidade Federal de São Paulo, São Paulo, Brazil.

出版信息

Transplant Proc. 2010 Nov;42(9):3655-9. doi: 10.1016/j.transproceed.2010.06.030.

DOI:10.1016/j.transproceed.2010.06.030

PMID:21094834

Abstract

BACKGROUND

Simultaneous pancreas-kidney transplantation (SPKT) is one of the treatments for insulin-dependent chronic renal failure patients.

METHODS

One-year patient and kidney allograft survival rates of 150 patients undergoing SPKT were subjected to Cox regression and Kaplan-Meier analyses. Uni- and multivariate methods identified risk factors involved in allograft and patient survival.

RESULTS

One-year patient and kidney allograft survival rates were 82% and 80%, respectively. Delayed graft function (DGF) (P = .001; hazard ratio [HR]5.41) and acute kidney rejection episodes (P = .016; HR 3.36) were related to 1 year patient survival as well as intra-abdominal infection (IAI) rates. (IAI). One-year kidney allograft survival was related to DGF (P = .013; odds ratio [OR] 3.39), acute rejection (P = .001; OR 4.74), and IAI (P = .003, OR 6.29). DGF was related to a time on dialysis >27 months (P = .046; OR 2.59), cold kidney ischemia time >14 hours (P = .027; OR 2.94), donor age >25 years (P = .03; OR 2.82), and donor serum sodium concentration >155 mEq/L (P < .0001; OR 1.09). Female kidney to male recipient in 17% of the cases did not increase the risk of DGF. We observed an important correlation between donor serum sodium and creatinine (P < .0001), which suggested undertreatment of diabetes insipidus secondary to brain death.

CONCLUSIONS

DGF, acute rejection, and IAI were the main determinants of survival after SPKT. Improving the care of deceased donors may reduce DGF occurrence.

摘要

背景

胰肾联合移植（SPKT）是胰岛素依赖型慢性肾衰竭患者的治疗方法之一。

方法

对150例行SPKT患者的1年患者及肾移植存活率进行Cox回归分析和Kaplan-Meier分析。单因素和多因素方法确定了影响移植肾和患者存活的危险因素。

结果

1年患者及肾移植存活率分别为82%和80%。移植肾功能延迟（DGF）（P = 0.001；风险比[HR]5.41）、急性肾排斥反应发作（P = 0.016；HR 3.36）与1年患者存活率以及腹腔内感染（IAI）率相关。1年移植肾存活率与DGF（P = 0.013；优势比[OR]3.39）、急性排斥反应（P = 0.001；OR 4.74）和IAI（P = 0.003，OR 6.29）相关。DGF与透析时间>27个月（P = 0.046；OR 2.59）、冷缺血时间>14小时（P = 0.027；OR 2.94）、供体年龄>25岁（P = 0.03；OR 2.82）以及供体血清钠浓度>155 mEq/L（P < 0.0001；OR 1.09）有关。17%的女性供肾给男性受者并未增加DGF风险。我们观察到供体血清钠与肌酐之间存在重要相关性（P < 0.0001），这提示继发于脑死亡的尿崩症治疗不足。