Chen G D, Gu J L, Zhang X D, Qiu J, Wang C X, Chen L Z
Organ Transplant Center, The First Affiliated Hospital of Sun Yat-sen University, Sun Yat-sen University, Guangzhou, China.
Transplant Proc. 2013 May;45(4):1445-8. doi: 10.1016/j.transproceed.2012.11.015.
The aim of this study was to explore donor risk factors that predict the poor outcomes after living donor kidney transplantation.
We retrospectively analyzed our 219 living donor kidney transplantations collecting donor age and gender, graft glomeular filtration rate (GFR), human leukocyte antigen (HLA) typing, recipient age and gender, acute rejection episodes chronic rejection, and 1-year serum creatinine level. Patient and graft survivals were calculated using the Kaplan-Meier analysis. Independent donor risk factors affecting graft survival and 1-year serum creatinine level were analyzed using Cox regression and logistic regression.
One-, 3-, 5-year patient and graft survivals were 98.6%, 98.1%, and 97.4% and 97.7%, 95.0%, and 92.2%, respectively. Acute rejection rate was 12.8%, and chronic rejection, 4.1%. If donor age was over 50 years, there were significantly increased incidences of acute and chronic rejection (χ(2) were 5.385 and 5.039; P < .05). Univariate analysis showed donor age > 50 years, graft GFR < 35 mL/min, female to male, HLA mismatch > 3 loci to be risk factors for an abnormal 1-year serum creatinine. Logistic multivariate regression revealed donor age > 50 years, female to male, and graft GFR before transplant < 35 mL/min to be independent risk factors for an abnormal 1-year serum creatinine level (odds ratio values 5.928, 2.489, and 6.993, respectively; P < .05). Cox multivariate regression demonstrated that graft GFR before transplant < 35 mL/min was an independent risk factor for long-term graft survival (relative risk value = 6.984; P = .004).
Older donor, female to male, and insufficient graft GFR before transplantation are predictive factors for poor outcomes of living donor kidney transplantations.
本研究旨在探索预测活体肾移植术后不良预后的供体风险因素。
我们回顾性分析了219例活体肾移植病例，收集了供体的年龄和性别、移植肾肾小球滤过率（GFR）、人类白细胞抗原（HLA）分型、受体的年龄和性别、急性排斥反应发作、慢性排斥反应以及1年时的血清肌酐水平。采用Kaplan-Meier分析计算患者和移植肾的生存率。使用Cox回归和逻辑回归分析影响移植肾存活和1年血清肌酐水平的独立供体风险因素。
1年、3年、5年的患者和移植肾生存率分别为98.6%、98.1%、97.4%和97.7%、95.0%、92.2%。急性排斥反应发生率为12.8%，慢性排斥反应发生率为4.1%。如果供体年龄超过50岁，急性和慢性排斥反应的发生率显著增加（χ²分别为5.385和5.039；P <.05）。单因素分析显示，供体年龄>50岁、移植肾GFR<35 mL/min、女性供体至男性受体、HLA错配>3个位点是1年血清肌酐异常的风险因素。逻辑多因素回归显示，供体年龄>50岁、女性供体至男性受体以及移植前移植肾GFR<35 mL/min是1年血清肌酐水平异常的独立风险因素（比值比分别为5.928、2.489和6.993；P <.05）。Cox多因素回归表明，移植前移植肾GFR<35 mL/min是长期移植肾存活的独立风险因素（相对风险值=6.984；P =.004）。
供体年龄较大、女性供体至男性受体以及移植前移植肾GFR不足是活体肾移植预后不良的预测因素。
