Department of Medicine, Section of Nephrology, Yale University School of Medicine and the Clinical Epidemiology Research Center, VAMC, New Haven, CT 06516, USA.
Am J Nephrol. 2011;33(5):407-13. doi: 10.1159/000326753. Epub 2011 Apr 15.
BACKGROUND/AIMS: Clinical methods to predict allograft function soon after kidney transplantation are ineffective.
We analyzed urine cystatin C (CyC) in a prospective multicenter observational cohort study of deceased-donor kidney transplants to determine its peritransplant excretion pattern, utility for predicting delayed graft function (DGF) and association with 3-month graft function. Serial urine samples were collected for 2 days following transplant and analyzed blindly for CyC. We defined DGF as any hemodialysis in the first week after transplant, slow graft function (SGF) as a serum creatinine reduction < 70% by the first week and immediate graft function (IGF) as a reduction ≥ 70%.
Of 91 recipients, 33 had DGF, 34 had SGF and 24 had IGF. Urine CyC/urine creatinine was highest in DGF for all time-points. The area under the curve (95% CI) for predicting DGF at 6 h was 0.69 (0.57-0.81) for urine CyC, 0.74 (0.62-0.86) for urine CyC/urine creatinine and 0.60 (0.45-0.75) for percent change in urine CyC. On the first postoperative day, urine CyC/urine creatinine and percent change in urine CyC were associated with 3-month graft function.
Urine CyC on the day after transplant differs between degrees of perioperative graft function and modestly corresponds with 3-month function.
背景/目的：临床方法在肾移植后不久预测移植物功能效果不佳。
我们在一项前瞻性多中心观察队列研究中分析了尸体供肾移植患者的尿胱抑素 C（CyC），以确定其移植前的排泄模式、预测延迟移植物功能障碍（DGF）的效用及其与 3 个月移植物功能的关系。在移植后 2 天内连续采集尿液样本，并对 CyC 进行盲法分析。我们将 DGF 定义为移植后第 1 周内任何血液透析，SGF 定义为第 1 周内血清肌酐降低<70%，IGF 定义为降低≥70%。
91 例受者中，33 例发生 DGF，34 例发生 SGF，24 例发生 IGF。在所有时间点，DGF 患者的尿 CyC/尿肌酐均最高。6 h 时预测 DGF 的曲线下面积（95%CI）为尿 CyC 为 0.69（0.57-0.81），尿 CyC/尿肌酐为 0.74（0.62-0.86），尿 CyC 变化百分比为 0.60（0.45-0.75）。术后第 1 天，尿 CyC/尿肌酐和尿 CyC 变化百分比与 3 个月移植物功能相关。
移植后第 1 天的尿 CyC 在不同程度的围手术期移植物功能之间存在差异，与 3 个月功能有一定的对应关系。
