Miglinas M, Supranaviciene L, Mateikaite K, Skebas K, Kubiliene A
Vilnius University, Vilnius University Hospital, Santariskiu Klinikos, Vilnius, Lithuania.
Transplant Proc. 2013 May;45(4):1363-7. doi: 10.1016/j.transproceed.2013.03.014.
Delayed graft function (DGF), a well-known immediate postoperative complication is defined as the need for dialysis during the first week after deceased donor kidney transplantation. It affects 25% to 50% of recipients. In this study we identified risk factors for DGF and its impact on patient and graft survivals.
We retrospectively analyzed medical records from renal transplant recipients aged above 18 years who received a deceased donor kidney graft between November 2008 and December 2011, excluding kidney losses during the first week.
Among 137 transplantations, 64 (46.5%) displayed DGF. Multivariate analysis showed secondary renal disease (OR 3.7, CI 1.36-10.30; P = .011), HLA mismatches > 3 (OR 4.4, CI 1.53-12.51; P = .006) and donor urine output ≤ 3000 ml/24h (OR 25.8, CI 3.60-185.70; P = .001) to be significant risk factors for DGF. The hospitalization time was longer in the DGF group (38,2 ± 20,75 vs. 25,6 ± 8,18; P < .001). At 1 month, DGF group showed worse graft function based upon serum creatinine: 207.7 ± 148.52 vs 118.1 ± 36.63 μmol/L (P < .001). At 1 year follow-up, incidence of biopsy-proven acute renal rejection episodes was higher in the DGF (28; 51,9%) vs. the non-DGF group (18; 33,3%; P = .05). The 1-year recipient survival in DGF and no DGF groups were 90% vs 97% respectively (P = .124). With 1-year death censored graft survivals of 92% vs 100% respectively (P = .062).
Secondary renal disease, HLA mismatches and lower donor urinary output were associated with a greater incidence of DGF, leading to prolonged hospitalizations and an increased risk for an acute rejection episode.
移植肾功能延迟恢复（DGF）是一种众所周知的术后即刻并发症，定义为在尸体供肾移植后的第一周内需要进行透析。它影响25%至50%的受者。在本研究中，我们确定了DGF的危险因素及其对患者和移植物存活的影响。
我们回顾性分析了2008年11月至2011年12月期间接受尸体供肾移植的18岁以上肾移植受者的病历，排除第一周内的肾丢失情况。
在137例移植中，64例（46.5%）出现DGF。多因素分析显示继发性肾病（比值比3.7，可信区间1.36 - 10.30；P = 0.011）、HLA错配>3（比值比4.4，可信区间1.53 - 12.51；P = 0.006）和供体尿量≤3000 ml/24小时（比值比25.8，可信区间3.60 - 185.70；P = 0.001）是DGF的显著危险因素。DGF组的住院时间更长（38.2±20.75天对25.6±8.18天；P < 0.001）。在1个月时，根据血清肌酐水平，DGF组的移植物功能更差：207.7±148.52对118.1±36.63 μmol/L（P < 0.001）。在1年随访时，经活检证实的急性肾排斥反应发作的发生率在DGF组（28例；51.9%）高于非DGF组（18例；33.3%；P = 0.05）。DGF组和非DGF组的1年受者生存率分别为90%和97%（P = 0.124）。以1年死亡为截尾值的移植物生存率分别为92%和100%（P = 0.062）。
继发性肾病、HLA错配和较低的供体尿量与DGF的发生率较高相关，导致住院时间延长和急性排斥反应发作的风险增加。
