Qi Guisheng, Tang Qunye, Rong Ruiming
Department of Urology, Zhongshan Hospital, Fudan University, 180 Fenglin Road, Shanghai, 200032, People's Republic of China.
Shanghai Key Laboratory of Organ Transplantation, Shanghai, People's Republic of China.
Eur J Med Res. 2014 Dec 24;19(1):72. doi: 10.1186/s40001-014-0072-6.
This study aimed to investigate the relationship between the dynamic changes of estimated glomerular filtration rate (eGFR) in the early stage post renal transplantation and renal allograft dysfunction.
We selected 9 patients with interstitial fibrosis and tubular atrophy (IF/TA) and 11 patients with stable renal function based on the Banff 2007 classification system. Pathology of the patients was evidenced with renal biopsy results. Glomerular filtration rate (GFR) was calculated continuously for 14 days post-transplantation by using an estimated GFR (eGFR) formula adjusted into Chinese. Linear regression was employed, and eGFR slopes were compared. Prisoners or organs from prisoners were not used in this study.
The eGFR slope in the IF/TA group was significantly higher than that in the stable group (P < 0.01), and a cut-off value of 5.11 mL/min/1.73 m(2)/d was a reliable clinical value in a receiver operating characteristic (ROC) curve. On the basis of the ROC area under the curve, predictive accuracy of the eGFR slope was excellent (0.848). In conclusion, the eGFR in IF/TA increased faster within a period of 14 days post-transplantation, suggesting that reperfusion in the early stage may damage the glomerular filtration membrane to some extent. Furthermore, reperfusion might adversely affect long-term renal allograft survival.
本研究旨在探讨肾移植术后早期估算肾小球滤过率（eGFR）的动态变化与肾移植功能障碍之间的关系。
根据2007年班夫分类系统，我们选择了9例伴有间质纤维化和肾小管萎缩（IF/TA）的患者以及11例肾功能稳定的患者。患者的病理情况通过肾活检结果得以证实。使用调整为中文的估算肾小球滤过率（eGFR）公式，在移植后连续14天计算肾小球滤过率（GFR）。采用线性回归，并比较eGFR斜率。本研究未使用囚犯或来自囚犯的器官。
IF/TA组的eGFR斜率显著高于稳定组（P < 0.01），在受试者工作特征（ROC）曲线中，5.11 mL/min/1.73 m²/d的截断值是一个可靠的临床值。基于曲线下面积，eGFR斜率的预测准确性极佳（0.848）。总之，IF/TA患者在移植后14天内eGFR升高更快，这表明早期再灌注可能在一定程度上损害肾小球滤过膜。此外，再灌注可能对肾移植长期存活产生不利影响。
