肾移植供者特征指数对移植肾功能延迟恢复及移植结局的影响：单中心分析。
The impact of kidney donor profile index on delayed graft function and transplant outcomes: A single-center analysis.
机构信息
Division of Transplantation, Department of Surgery, University of Wisconsin School of Medicine and Public Health, University of Wisconsin, Madison, WI, USA.
Division of Statistics, Department of Surgery, University of Wisconsin School of Medicine and Public Health, University of Wisconsin, Madison, WI, USA.
出版信息
Clin Transplant. 2018 Mar;32(3):e13190. doi: 10.1111/ctr.13190.
INTRODUCTION
Renal transplant outcomes result from a combination of factors. Traditionally, donor factors were summarized by classifying kidneys as extended criteria or standard criteria. In 2014, the nomenclature changed to describe donor factors with the kidney donor profile index (KDPI). We aim to evaluate the relationship between KDPI and delayed graft function (DGF), and the impact KDPI on transplant outcomes for both donor after cardiac death (DCD) and donor after brain death (DBD).
METHODS
An IRB-approved single-center retrospective chart review was performed from January 1999 to July 2013. The patients were divided into six groups: DBD KDPI ≤60, DBD KPDI 61-84, DBD KDPI ≥85, DCD KDPI ≤60, DCD KPDI 61-84, and DCD KDPI ≥85. Rates of DGF, patient survival, and graft survival were examined among groups.
RESULTS
A total of 2161 kidney transplants were included. DGF rates increased, and graft and patient survival decreased with increasing KDPI (P < .001). DCD kidneys had higher DGF rates than their DBD counterparts (P < .001). In DCD kidneys, a higher KDPI score did not significantly affect the DGF rates (P > .302). There was no significant difference in graft or patient survival in all-comers when comparing DCD and DBD kidneys with equivalent KDPIs (P > .317). Patients with DGF across all categories demonstrated worse graft half-lives.
CONCLUSION
The KDPI system is an accurate predictor of donor contributions to transplant outcomes. Recipients of DBD kidneys experience an increase in the rate of DGF as their KDPI increases. DCD kidneys have higher DGF rates than their DBD counterparts with similar KDPIs. Patients with documented post-transplant DGF had between 3- and 5-year shorter graft half-lives when compared to recipients that did not experience DGF. Initiatives to reduce the rate of DGF could provide a significant impact on graft survival and result in a reduction in the number of patients requiring retransplant.
介绍
肾移植的结果是多种因素共同作用的结果。传统上，通过将肾脏分类为扩展标准或标准标准来总结供体因素。2014 年，命名法改变，用肾脏供体特征指数（KDPI）来描述供体因素。我们旨在评估 KDPI 与延迟移植物功能障碍（DGF）之间的关系，以及 KDPI 对心脏死亡后供体（DCD）和脑死亡后供体（DBD）移植结局的影响。
方法
进行了一项经过机构审查委员会批准的单中心回顾性图表审查，时间为 1999 年 1 月至 2013 年 7 月。患者分为六组：DBD KDPI ≤60、DBD KPDI 61-84、DBD KDPI ≥85、DCD KDPI ≤60、DCD KPDI 61-84 和 DCD KDPI ≥85。检查了各组中 DGF、患者存活率和移植物存活率的发生率。
结果
共纳入 2161 例肾移植患者。随着 KDPI 的增加，DGF 率增加，移植物和患者存活率降低（P<0.001）。DCD 肾脏的 DGF 发生率高于 DBD 肾脏（P<0.001）。在 DCD 肾脏中，较高的 KDPI 评分并未显著影响 DGF 率（P>.302）。在比较具有等效 KDPIs 的 DCD 和 DBD 肾脏时，所有患者中移植物和患者存活率没有差异（P>.317）。在所有类别中，DGF 的患者显示出更短的移植物半衰期。
结论
KDPI 系统是预测供体对移植结果的准确指标。随着 KDPI 的增加，接受 DBD 肾脏的患者的 DGF 发生率增加。与具有相似 KDPIs 的 DBD 肾脏相比，DCD 肾脏的 DGF 发生率更高。与未发生 DGF 的患者相比，有记录的移植后 DGF 的患者的移植物半衰期短 3 至 5 年。减少 DGF 发生率的举措可能会对移植物存活率产生重大影响，并减少需要再次移植的患者数量。
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