一种基于移植后估计肾小球滤过率斜率的肾功能恢复的改进分类方法。

An Improved Classification of Kidney Function Recovery Using Estimated Glomerular Filtration Rate Slope Post-transplantation.

作者信息

Hassanain M, Simoneau E, Doi S A, Hebert M-J, Metrakos P, Tchervenkov J

机构信息

Department of Surgery, College of Medicine, King Saud University, Riyadh, Saudi Arabia; Section of Hepatobiliary Surgery and Solid Organ Transplant, Department of Surgery, McGill University Health Center, Montréal, Québec, Canada.

Section of Hepatobiliary Surgery and Solid Organ Transplant, Department of Surgery, McGill University Health Center, Montréal, Québec, Canada.

出版信息

Transplant Proc. 2016 Jul-Aug;48(6):1993-8. doi: 10.1016/j.transproceed.2016.03.055.

DOI:10.1016/j.transproceed.2016.03.055

PMID:27569934

Abstract

BACKGROUND

The impact of renal function recovery on graft survival was examined using estimated glomerular filtration rate (eGFR) slope after kidney transplantation (GAP classification); this was compared to the conventional classification of immediate graft function (IGF), slow graft function (SGF), and delayed graft function (DGF).

MATERIALS AND METHODS

Overall, 541 cases of cadaveric renal transplants were reviewed from a prospective transplant database. eGFR and its slope were measured using the harmonic mean over the first week post-transplantation. Next, 495 kidney transplant recipients from an independent institution were assessed to determine the prognostic value of graft function based on the eGFR slope.

RESULTS

The main discrimination of eGFR slopes occurred within the first 7 days. Three groups in the GAP classification (Good graft function, Average graft function, Poor graft function) were defined based on eGFR slope tertiles: good graft function (GGF), average graft function (AGF), and poor graft function (PGF) were defined based on the ΔCrCL per day over the first 7 days: <1 mL/min, 1-4 mL/min, and >4 mL/min, respectively. When applied to the validation cohort, the 5-year graft failure was 20% for the PGF group, 4% for the AGF group, and 3% for the GGF group. Multivariable Cox regression analysis demonstrated better prediction of long-term graft function with the new classification (C statistic 0.49 [old)] vs 0.61 [new]).

CONCLUSION

The new GAP criteria were better at predicting long-term graft survival and renal function compared to the conventional classification system, and deserve further consideration in future studies.

摘要

背景

使用肾移植后估计肾小球滤过率（eGFR）斜率（GAP分类）研究肾功能恢复对移植物存活的影响；并将其与即时移植物功能（IGF）、缓慢移植物功能（SGF）和延迟移植物功能（DGF）的传统分类进行比较。

材料与方法

总体而言，从一个前瞻性移植数据库中回顾了541例尸体肾移植病例。使用移植后第一周的调和平均值测量eGFR及其斜率。接下来，对来自一个独立机构的495名肾移植受者进行评估，以确定基于eGFR斜率的移植物功能的预后价值。

结果

eGFR斜率的主要区分发生在头7天内。基于eGFR斜率三分位数定义了GAP分类中的三组（良好移植物功能、中等移植物功能、不良移植物功能）：良好移植物功能（GGF）、中等移植物功能（AGF）和不良移植物功能（PGF）分别基于头7天每天的肌酐清除率变化（ΔCrCL）定义为：<1 mL/min、1 - 4 mL/min和>4 mL/min。应用于验证队列时，PGF组的5年移植物失败率为20%，AGF组为4%，GGF组为3%。多变量Cox回归分析表明，新分类对长期移植物功能的预测更好（C统计量0.49 [旧分类] 对 0.61 [新分类]）。