de Sandes-Freitas Tainá Veras, Felipe Cláudia Rosso, Aguiar Wilson Ferreira, Cristelli Marina Pontello, Tedesco-Silva Hélio, Medina-Pestana José Osmar
Nephrology Division, Hospital do Rim / Universidade Federal de São Paulo-UNIFESP, São Paulo, Brazil.
Urology Division, Hospital do Rim / Universidade Federal de São Paulo-UNIFESP, São Paulo, Brazil.
PLoS One. 2015 Dec 17;10(12):e0144188. doi: 10.1371/journal.pone.0144188. eCollection 2015.
It is unclear if there is an association between the duration of delayed graft function (DGF) and kidney transplant (KT) outcomes. This study investigated the impact of prolonged DGF on patient and graft survivals, and renal function one year after KT. This single center retrospective analysis included all deceased donor KT performed between Jan/1998 and Dec/2008 (n = 1412). Patients were grouped in quartiles according to duration of DGF (1-5, 6-10, 11-15, and >15 days, designated as prolonged DGF). The overall incidence of DGF was 54.2%. Prolonged DGF was associated with retransplantation (OR 2.110, CI95% 1.064-4.184,p = 0.033) and more than 3 HLA mismatches (OR 1.819, CI95% 1.117-2.962,p = 0.016). The incidence of acute rejection was higher in patients with DGF compared with those without DGF (36.2% vs. 12.2%, p<0.001). Compared to patients without DGF, DGF(1-5), DGF(6-10), and DGF(11-15), patients with prolonged DGF showed inferior one year patient survival (95.2% vs. 95.4% vs. 95.5% vs. 93.4% vs. 88.86%, p = 0.003), graft survival (91% vs. 91.4% vs. 92% vs. 88.7% vs. 70.5%, p<0.001), death-censored graft survival (95.7% vs. 95.4% vs. 96.4% vs. 94% vs. 79.3%, p<0.001), and creatinine clearance (58.0±24.6 vs. 55.8±22.2 vs. 53.8±24.1 vs. 53.0±27.2 vs. 36.8±27.0 mL/min, p<0.001), respectively. Multivariable analysis showed that prolonged DGF was an independent risk factor for graft loss (OR 3.876, CI95% 2.270-6.618, p<0.001), death censored graft loss (OR 4.103, CI95% 2.055-8.193, p<0.001), and death (OR 3.065, CI95% 1.536-6.117, p = 0.001). Prolonged DGF, determined by retransplantation and higher HLA mismatches, was associated with inferior renal function, and patient and graft survivals at one year.
延迟移植肾功能（DGF）的持续时间与肾移植（KT）结局之间是否存在关联尚不清楚。本研究调查了延长的DGF对患者和移植物存活以及KT术后一年肾功能的影响。这项单中心回顾性分析纳入了1998年1月至2008年12月期间进行的所有 deceased donor KT（n = 1412）。根据DGF的持续时间（1 - 5天、6 - 10天、11 - 15天和>15天，定义为延长的DGF）将患者分为四分位数。DGF的总体发生率为54.2%。延长的DGF与再次移植（OR 2.110，CI95% 1.064 - 4.184，p = 0.033）和超过3个HLA错配（OR 1.819，CI95% 1.117 - 2.962，p = 0.016）相关。与无DGF的患者相比，有DGF的患者急性排斥反应的发生率更高（36.2%对12.2%，p<0.001）。与无DGF的患者相比，DGF（1 - 5天）、DGF（6 - 10天）和DGF（11 - 15天）的患者，延长DGF的患者在一年时的患者存活率（95.2%对95.4%对95.5%对93.4%对88.86%，p = 0.003）、移植物存活率（91%对91.4%对92%对88.7%对70.5%，p<0.001）、死亡审查的移植物存活率（95.7%对95.4%对96.4%对94%对79.3%，p<0.001）和肌酐清除率（58.0±24.6对55.8±22.2对53.8±24.1对53.0±27.2对36.8±27.0 mL/分钟，p<0.001）均较差。多变量分析显示，延长的DGF是移植物丢失（OR 3.876，CI95% 2.270 - 6.618，p<0.001）、死亡审查的移植物丢失（OR 4.103，CI95% 2.055 - 8.193，p<0.001）和死亡（OR 3.065，CI95% 1.536 - 6.117，p = 0.001）的独立危险因素。由再次移植和更高的HLA错配所确定的延长的DGF与较差的肾功能以及一年时的患者和移植物存活率相关。
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