Baek Chung Hee, Kim Hyosang, Yang Won Seok, Han Duck Jong, Park Su-Kil
Division of Nephrology, Department of Internal Medicine, University of Ulsan College of Medicine, Seoul.
Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea.
Artif Organs. 2017 Apr;41(4):381-391. doi: 10.1111/aor.12753. Epub 2016 Sep 22.
The outcomes of transplantation have improved, but more than 50% of kidney transplantation (KT) recipients are still reported to have renal function of chronic kidney disease (CKD) stage 3 at 1 year after KT. We reviewed all 1235 patients who received a KT in our institution between 2008 and 2012. Among these recipients, 77 and 289 cases were included in the estimated glomerular filtration rate (eGFR) at 1 year after KT 30-44 (CKD stage 3b) group and eGFR 45-59 (CKD stage 3a) group, respectively. Longer duration of dialysis (odds ratio [OR] = 1.007, 95% confidence interval [CI], 1.000-1.014, P = 0.047), older donors (OR = 1.064, 95% CI, 1.031-1.098, P < 0.001), delayed graft function (OR = 3.601, 95% CI, 1.031-1.098, P < 0.001), BK virus infection (OR = 2.567, 95% CI, 1.242-5.305, P = 0.011), and pneumonia (OR = 4.451, 95% CI, 1.388-14.279, P = 0.012) were contributing factors to eGFR 30-44 mL/min. Especially, ureteral stricture occurred more frequently in eGFR 30-44 group of deceased donor KT. However, acute rejection was not a significant risk factor of lower eGFR. Graft survival was better in the eGFR 45-59 group. However, this difference was smaller in deceased donor KT. Infections and urologic complications are also important contributing factors of lower graft function in CKD stage 3. In addition, dividing CKD stage 3 into subgroups might be more useful in living donor kidney transplantation.
移植的效果已有改善，但仍有超过50%的肾移植（KT）受者在肾移植术后1年时被报告肾功能处于慢性肾脏病（CKD）3期。我们回顾了2008年至2012年期间在我院接受肾移植的所有1235例患者。在这些受者中，分别有77例和289例被纳入肾移植术后1年估算肾小球滤过率（eGFR）为30 - 44（CKD 3b期）组和eGFR 45 - 59（CKD 3a期）组。透析时间较长（比值比[OR]=1.007，95%置信区间[CI]，1.000 - 1.014，P = 0.047）、供者年龄较大（OR = 1.064，95% CI，1.031 - 1.098，P < 0.001）、移植肾功能延迟（OR = 3.601，95% CI，1.031 - 1.098，P < 0.001）、BK病毒感染（OR = 2.567，95% CI，1.242 - 5.305，P = 0.011）以及肺炎（OR = 4.451，95% CI，1.388 - 14.279，P = 0.012）是eGFR为30 - 44 mL/min的影响因素。特别是，输尿管狭窄在死亡供者肾移植的eGFR 30 - 44组中更频繁发生。然而，急性排斥反应并非eGFR降低的显著危险因素。eGFR 45 - 59组的移植肾存活率更高。然而，在死亡供者肾移植中这种差异较小。感染和泌尿系统并发症也是CKD 3期移植肾功能降低的重要影响因素。此外，将CKD 3期分为亚组在活体供肾移植中可能更有用。
