Heilman Raymond L, Smith Maxwell L, Smith Byron H, Qaqish Ibrahim, Khamash Hasan, Singer Andrew L, Kaplan Bruce, Reddy Kunam S
Departments of Medicine and.
Department of Laboratory Medicine and Pathology, Mayo Clinic, Phoenix, Arizona; and.
Clin J Am Soc Nephrol. 2016 Dec 7;11(12):2225-2232. doi: 10.2215/CJN.05060516. Epub 2016 Oct 24.
Delayed graft function is a form of AKI resulting from ischemia-reperfusion injury. Our aim was to study the effect of delayed graft function on the progression of interstitial fibrosis after deceased donor kidney transplantation.
DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: Our study is a retrospective study of all patients transplanted at our center between July of 2003 and September of 2014 using a kidney from a deceased donor. The primary outcome was the progression of interstitial fibrosis on serial protocol biopsies done during the first year post-transplant. We analyzed the distribution of the change in the Banff interstitial fibrosis (ci) score between the delayed graft function and nondelayed graft function groups for all of the paired biopsies done at time 0 and 12 months post-transplant (Δfibrosis). We also performed a linear mixed model analyzing the difference in the slopes for the progression of mean Banff ci score for all of the biopsies done at time 0 and 1, 4, and 12 months post-transplant.
There were 343 (36.7%) in the delayed graft function group and 591 in the control group. The biopsy rates for the delayed graft function and nondelayed graft function groups at time 0 were 65.3% (n=224) and 67.0% (n=396), respectively, and at 12 months, they were 64.4% (n=221) and 68.4% (n=404), respectively. Paired biopsies were available for 155 in the delayed graft function group and 283 in the control group. In a risk-adjusted model, Banff ci score >0 on the time 0 biopsy had a higher odds of delayed graft function (odds ratio, 1.70; 95% confidence interval, 1.03 to 2.82). The distribution of the Δfibrosis between 0 and 12 months was similar in delayed graft function and control groups (P=0.91). The slopes representing the progression of fibrosis were also similar between the groups (P=0.66).
Donor-derived fibrosis may increase the odds of delayed graft function; however, delayed graft function does not seem to increase the progression of fibrosis during the first year after transplantation.
移植肾功能延迟是由缺血再灌注损伤导致的急性肾损伤的一种形式。我们的目的是研究移植肾功能延迟对尸体供肾移植后间质纤维化进展的影响。
设计、地点、参与者与测量方法：我们的研究是一项回顾性研究，纳入了2003年7月至2014年9月间在本中心接受尸体供肾移植的所有患者。主要结局是移植后第一年期间连续方案活检时间质纤维化的进展情况。我们分析了移植后0个月和12个月时所有配对活检中，移植肾功能延迟组与非移植肾功能延迟组之间班夫间质纤维化（ci）评分变化的分布情况（Δ纤维化）。我们还进行了线性混合模型分析，以研究移植后0个月、1个月、4个月和12个月时所有活检中平均班夫ci评分进展斜率的差异。
移植肾功能延迟组有343例（36.7%），对照组有591例。移植肾功能延迟组和非移植肾功能延迟组在0个月时的活检率分别为65.3%（n = 224）和67.0%（n = 396），在12个月时分别为64.4%（n = 221）和68.4%（n = 404）。移植肾功能延迟组有155例、对照组有283例可进行配对活检。在风险调整模型中，移植后0个月活检时班夫ci评分>0与移植肾功能延迟的可能性更高相关（优势比，1.70；95%置信区间，1.03至2.82）。移植肾功能延迟组与对照组在0至12个月间的Δ纤维化分布相似（P = 0.91）。两组间代表纤维化进展的斜率也相似（P = 0.66）。
供体来源的纤维化可能增加移植肾功能延迟的几率；然而，移植肾功能延迟在移植后的第一年似乎并不会增加纤维化的进展。
