Department of Surgery, University of Saskatchewan, Saskatoon, SK, Canada.
Nephrol Dial Transplant. 2014 Jan;29(1):203-8. doi: 10.1093/ndt/gft412. Epub 2013 Oct 28.
We hypothesize that in patients with delayed graft function (DGF), the need for a longer time needed on dialysis (TND) post-kidney transplant is associated with poorer long-term function and an increase in complications.
This was a retrospective chart review involving collaboration between Western University (WU) Renal Transplant Program of London, Ontario and the Saskatchewan renal transplant program (SRTP). A total of 774 patients (567 WU and 207 SRTP) received kidney transplants between 2004 and 2011, of which 83 patients with deceased donor transplants (59 WU and 24 SRTP) developed DGF, defined as the need for dialysis in the first week posttransplant.
Patients with DGF were divided into three groups depending on TND [group 1: <7 days (n = 52), group 2: 7-14 days (n = 13) and group 3 (n = 18): >14 days]. The creatinine clearance (CrCl) at 30 days (42.5, 33.8, 20.0 cc/min; P < 0.001) and 1 year (56.7, 49.2, 37.3 cc/min, P = 0.031) were significantly different between the three groups. Multivariate regression analysis identified length of TND posttransplant (β = -0.5, P < 0.001) and donation after cardiac death (DCD) donor (β = 19.5, P < 0.001) as the most significant predictors of CrCl at 1 year in these patients with DGF. DCD kidneys with DGF had a higher CrCl at 1 year and fewer readmissions in the first year compared with non-DCD kidneys with DGF.
Our study suggests that increased TND is associated with worse CrCl at 1 year. The data also support the hypothesis of a different mechanism for DGF in DCD and non-DCD kidneys.
我们假设在发生延迟移植物功能（DGF）的患者中，移植后需要透析的时间（TND）较长与长期功能较差和并发症增加有关。
这是一项回顾性图表研究，涉及安大略省伦敦西部大学（WU）肾脏移植项目和萨斯喀彻温省肾脏移植项目（SRTP）之间的合作。共有 774 名患者（567 名 WU 和 207 名 SRTP）于 2004 年至 2011 年期间接受了肾脏移植，其中 83 名接受了已故供体移植的患者（59 名 WU 和 24 名 SRTP）发生了 DGF，定义为在移植后第一周需要透析。
根据 TND 将 DGF 患者分为三组[组 1：<7 天（n = 52），组 2：7-14 天（n = 13）和组 3（n = 18）：>14 天]。三组患者在 30 天（42.5、33.8、20.0 cc/min；P<0.001）和 1 年（56.7、49.2、37.3 cc/min，P=0.031）时的肌酐清除率（CrCl）均有显著差异。多变量回归分析确定移植后 TND 的长度（β=-0.5，P<0.001）和心脏死亡后供体（DCD）供体（β=19.5，P<0.001）是这些 DGF 患者 1 年时 CrCl 的最显著预测因子。与 DGF 中非 DCD 肾脏相比，DGF 中的 DCD 肾脏在 1 年内具有更高的 CrCl 和更少的再次入院。
我们的研究表明，TND 的增加与 1 年时的 CrCl 较差相关。数据还支持 DCD 和非 DCD 肾脏中 DGF 发生机制不同的假设。
