心脏死亡后供肾移植中移植肾功能延迟与移植肾丢失之间的关联——一项配对肾登记分析

Association Between Delayed Graft Function and Graft Loss in Donation After Cardiac Death Kidney Transplants-A Paired Kidney Registry Analysis.

作者信息

Lim Wai H, McDonald Stephen P, Russ Graeme R, Chapman Jeremy R, Ma Maggie Km, Pleass Henry, Jaques Bryon, Wong Germaine

机构信息

1 Department of Renal Medicine, Sir Charles Gairdner Hospital, Western Australia, Australia. 2 Australia and New Zealand Dialysis and Transplant Registry, South Australia, Australia. 3 Central and Northern Adelaide Renal and Transplantation Services, South Australia, Australia. 4 Centre for Transplant and Renal Research, Westmead Hospital, New South Wales, Australia. 5 Department of Medicine, Queen Mary Hospital, Hong Kong. 6 Western Australia Kidney and Liver Transplant Service, Sir Charles Gairdner Hospital, Western Australia, Australia. 7 Centre for Kidney Research, The Children's Hospital at Westmead, New South Wales, Australia. 8 Sydney School of Public Health, University of Sydney, New South Wales, Australia.

出版信息

Transplantation. 2017 Jun;101(6):1139-1143. doi: 10.1097/TP.0000000000001323.

DOI:10.1097/TP.0000000000001323

PMID:28538652

Abstract

BACKGROUND

Delayed graft function (DGF) is an established complication after donation after cardiac death (DCD) kidney transplants, but the impact of DGF on graft outcomes is uncertain. To minimize donor variability and bias, a paired donor kidney analysis was undertaken where 1 kidney developed DGF and the other did not develop DGF using data from the Australia and New Zealand Dialysis and Transplant Registry.

METHODS

Using paired DCD kidney data from the Australia and New Zealand Dialysis and Transplant Registry, we examined the association between DGF, graft and patient outcomes between 1994 and 2012 using adjusted Cox regression models.

RESULTS

Of the 74 pairs of DCD kidneys followed for a median of 1.9 years (408 person-years), a greater proportion of recipients with DGF had experienced overall graft loss and death-censored graft loss at 3 years compared with those without DGF (14% vs 4%, P = 0.04 and 11% vs 0%, P < 0.01, respectively). Compared with recipients without DGF, the adjusted hazard ratio for overall graft loss at 3 years for recipients with DGF was 4.31 (95% confidence interval [95% CI], 1.13-16.44). The adjusted hazard ratio for acute rejection and all-cause mortality at 3 years in recipients who have experienced DGF were 0.98 (95% CI, 0.96-1.01) and 1.70 (95% CI, 0.36-7.93), respectively, compared with recipients without DGF.

CONCLUSIONS

Recipients of DCD kidneys with DGF experienced a higher incidence of overall and death-censored graft loss compared with those without DGF. Strategies aim to reduce the risk of DGF could potentially improve graft survival in DCD kidney transplants.

摘要

背景

延迟移植肾功能（DGF）是心脏死亡后捐赠（DCD）肾移植术后一种公认的并发症，但DGF对移植肾结局的影响尚不确定。为了尽量减少供体变异性和偏差，利用澳大利亚和新西兰透析与移植登记处的数据，进行了配对供体肾分析，其中一个肾发生了DGF，另一个未发生DGF。

方法

利用澳大利亚和新西兰透析与移植登记处的配对DCD肾数据，我们使用校正后的Cox回归模型研究了1994年至2012年间DGF、移植肾和患者结局之间的关联。

结果

在随访中位时间为1.9年（408人年）的74对DCD肾中，与未发生DGF的受者相比，发生DGF的受者在3年时总体移植肾丢失和死亡审查移植肾丢失的比例更高（分别为14%对4%，P = 0.04；11%对0%，P < 0.01）。与未发生DGF的受者相比，发生DGF的受者在3年时总体移植肾丢失的校正风险比为4.31（95%置信区间[95%CI]，1.13 - 16.44）。与未发生DGF的受者相比，发生DGF的受者在3年时急性排斥反应和全因死亡率的校正风险比分别为0.98（95%CI，0.96 - 1.01）和1.70（95%CI，0.36 - 7.93）。