Decruyenaere Philippe, Decruyenaere Alexander, Peeters Patrick, Vermassen Frank
Department of Nephrology, Ghent University Hospital, Ghent, Belgium.
Department of Thoracic and Vascular Surgery, Ghent University Hospital, Ghent, Belgium.
Ann Transplant. 2016 Mar 15;21:152-9. doi: 10.12659/aot.896117.
This study compared 22 different definitions of delayed graft function (DGF) following kidney transplantation.
Our study included 497 kidney transplantations from deceased donors at our center between 2005 and 2011. Graft survival analysis including log-rank tests and Cox proportional hazards model was performed. Sensitivity and specificity were calculated in relation to graft failure.
Mean follow-up time was 5.1 years. All dialysis-based definitions were associated with graft failure and characterized by high specificity (88-97%), but low sensitivity (25-29%). Hazard ratios ranged from 2.87 to 13.73, with increased risk when dialysis was required earlier and more frequently. The urine output-based definition performed similarly, with an association with graft failure and high specificity (96%), but low sensitivity (21%). Serum creatinine-based definitions were more heterogeneous. Higher sensitivity (4-67%) was found in some of these definitions, but was often associated with lower specificity (47-96%), losing the association with graft failure. Definitions combining different criteria varied in sensitivity (17-62%) and specificity (60-96%). However, some were able to achieve higher sensitivity without compromising too much on specificity, while keeping the association with graft failure.
Our results indicate a potential advantage of combined definitions, because they are able to detect a larger group of recipients with increased risk of graft failure.
本研究比较了肾移植后延迟移植肾功能（DGF）的22种不同定义。
我们的研究纳入了2005年至2011年期间在本中心进行的497例来自已故供体的肾移植。进行了包括对数秩检验和Cox比例风险模型的移植存活分析。计算了与移植失败相关的敏感性和特异性。
平均随访时间为5.1年。所有基于透析的定义均与移植失败相关，其特点是特异性高（88 - 97%），但敏感性低（25 - 29%）。风险比范围为2.87至13.73，当更早且更频繁地需要透析时风险增加。基于尿量的定义表现类似，与移植失败相关且特异性高（96%），但敏感性低（21%）。基于血清肌酐的定义更为多样。其中一些定义具有较高的敏感性（4 - 67%），但通常与较低的特异性（47 - 96%）相关，失去了与移植失败的关联。结合不同标准的定义在敏感性（17 - 62%）和特异性（60 - 96%）方面各不相同。然而，一些定义能够在不显著降低特异性的情况下实现更高的敏感性，同时保持与移植失败的关联。
我们的结果表明联合定义具有潜在优势，因为它们能够检测出更大一组移植失败风险增加的受者。
