选定因素对肾移植长期存活的影响——多变量分析

Influence of selected factors on long-term kidney graft survival--a multivariable analysis.

作者信息

Zukowski M, Kotfis K, Kaczmarczyk M, Biernawska J, Szydłowski L, Zukowska A, Sulikowski T, Sierocka A, Bohatyrewicz R

机构信息

Department of Anesthesiology, Intensive Care and Acute Poisoning, Pomeranian Medical University, Szczecin, Poland.

出版信息

Transplant Proc. 2014 Oct;46(8):2696-8. doi: 10.1016/j.transproceed.2014.08.016.

DOI:10.1016/j.transproceed.2014.08.016

PMID:25380897

Abstract

BACKGROUND

Long-term function of transplanted kidney is the factor determining quality of life for transplant recipients. The aim of this study was to evaluate the effect of selected factors on time of graft function after renal transplantation within 15 years of observation.

METHODS

Preoperative and intraoperative factors were analyzed in 232 kidney recipients within a 15-year observation period. Analysis included age, sex, cause of recipient's renal failure, length of hemodialyses before transplantation, peak panel reactive antibodies test, human leukocyte antigen compatibility, cold ischemia time, delayed graft function occurrence, length and time of hemodialyses after transplantation, early graft rejection, creatinine level at days 1, 3, 7, 30, 90, and 180 after transplantation, and influence of these factors on the time of graft function. Statistical analysis was performed with the use of univariate and multivariate Kaplan-Meier test and Cox regression proportional hazards model, with P < .05 considered to be significant.

RESULTS

Univariate analysis showed significantly shorter renal graft function in the group of recipients with higher creatinine levels in all of the analyzed time periods and in patients experiencing delayed graft function. Length of time of hemodialyses after transplantation and number of dialyses had significant impact on worsening of late transplant results. Multivariate analysis reported that early graft rejection in the postoperative period is an independent factor improving late graft function: P = .002; hazard ratio (HR), 0.49 (95% confidence interval [CI], 0.31-0.78). Higher creatinine level at day 90 after kidney transplantation is a predictive factor of late graft dysfunction: P = .002; HR, 1.68 (95% CI 1.2-2.35).

CONCLUSIONS

Creatinine level at day 90 after renal transplantation is the prognostic factor of long-term kidney function. Early transplant rejection leads to introduction of more aggressive immunosuppression protocol, which improves long-term transplant results.

摘要

背景

移植肾的长期功能是决定移植受者生活质量的因素。本研究的目的是在15年的观察期内评估所选因素对肾移植后移植肾功能时间的影响。

方法

在15年的观察期内，对232例肾移植受者的术前和术中因素进行分析。分析内容包括年龄、性别、受者肾衰竭病因、移植前血液透析时间、群体反应性抗体峰值检测、人类白细胞抗原相容性、冷缺血时间、移植肾功能延迟发生情况、移植后血液透析时间和次数、早期移植排斥反应、移植后第1、3、7、30、90和180天的肌酐水平，以及这些因素对移植肾功能时间的影响。采用单因素和多因素Kaplan-Meier检验以及Cox回归比例风险模型进行统计分析，P < 0.05被认为具有统计学意义。

结果

单因素分析显示，在所有分析时间段内肌酐水平较高的受者组以及发生移植肾功能延迟的患者中，肾移植功能明显较短。移植后血液透析时间和透析次数对晚期移植结果的恶化有显著影响。多因素分析表明，术后早期移植排斥反应是改善晚期移植功能的独立因素：P = 0.002；风险比（HR）为0.49（95%置信区间[CI]，0.31 - 0.78）。肾移植后第90天较高的肌酐水平是晚期移植功能障碍的预测因素：P = 0.002；HR为1.68（95% CI 1.2 - 2.35）。