Arshad Adam, Hodson James, Chappelow Imogen, Nath Jay, Sharif Adnan
College of Medical and Dental Sciences, University of Birmingham, Birmingham, United Kingdom.
Department of Nephrology and Transplantation, Queen Elizabeth Hospital Birmingham, Birmingham, United Kingdom.
Transplant Direct. 2018 Sep 7;4(10):e391. doi: 10.1097/TXD.0000000000000826. eCollection 2018 Oct.
Nephron endowment in renal transplantation is infrequently considered, but may have important implications for post kidney transplantation outcomes. In this population-cohort study, we analyzed the deceased-donor kidney transplant outcomes stratified by donor-to-recipient size ratios.
Data for all deceased-donor adult kidney transplantation recipients between 2003 and 2015 were extracted from the UK Transplant Registry. We used weight as a surrogate marker for kidney size and defined the following mismatch categories (donor weight/recipient weight × 100): less than 75% (small donor kidney), 75% to 125% (weight matched kidney), and greater than 125% (large donor kidney). Univariable and multivariable analyses were undertaken to assess the relationship between this marker and patient outcomes.
Outcomes for 11 720 transplants were analyzed with weight mismatch stratified as follows; small donor kidney (n = 1608, 13.7%), weight matched kidney (n = 7247, 61.8%) and large donor kidney (n = 2865, 24.4%). On multivariable analysis, no significant differences were detected in overall ( = 0.876) or death-censored ( = 0.173) graft survival, or in rates of delayed graft function ( = 0.396) between these 3 groups. However, 12-month creatinine levels were found to decline progressively across the groups ( < 0.001), with adjusted averages of 144.2 μmol/L for recipients of small donor kidneys, 134.7 μmol/L in weight matched kidneys, and 124.9 μmol/L in recipients of large donor kidneys. In addition, patient survival was found to be significantly shorter in recipients of larger kidneys than those with weight matched kidneys (hazard ratio, 1.21; 95% confidence interval, 1.05-1.40; = 0.009), which is inconsistent with the existing literature.
Our data demonstrate that 12-month creatinine is influenced by donor-to-recipient difference in body weight, but that no such difference is observed for either delayed graft function or death-censored graft survival. However, we observed increased mortality in recipients receiving larger kidneys; an observation which conflicts with the existing literature and warrants further investigation.
肾移植中肾单位数量很少被考虑，但可能对肾移植术后结果有重要影响。在这项人群队列研究中，我们分析了根据供体与受体大小比分层的尸体供肾移植结果。
从英国移植登记处提取2003年至2015年间所有尸体供肾成年肾移植受者的数据。我们用体重作为肾脏大小的替代指标，并定义了以下不匹配类别（供体体重/受体体重×100）：小于75%（小供体肾）、75%至125%（体重匹配肾）和大于125%（大供体肾）。进行单变量和多变量分析以评估该指标与患者预后之间的关系。
分析了11720例移植的结果，体重不匹配情况分层如下：小供体肾（n = 1608，13.7%）、体重匹配肾（n = 7247，61.8%）和大供体肾（n = 2865，24.4%）。多变量分析显示，这三组之间在总体移植存活率（P = 0.876）、死亡删失移植存活率（P = 0.173）或移植肾功能延迟发生率（P = 0.396）方面均未检测到显著差异。然而，发现三组间12个月时的肌酐水平呈逐渐下降趋势（P < 0.001），小供体肾受者的校正平均值为144.2μmol/L，体重匹配肾受者为134.7μmol/L，大供体肾受者为124.9μmol/L。此外，发现接受较大肾脏的受者的患者存活率显著低于体重匹配肾脏的受者（风险比，1.21；95%置信区间，1.05 - 1.40；P = 0.009），这与现有文献不一致。
我们的数据表明，12个月时的肌酐水平受供体与受体体重差异的影响，但在移植肾功能延迟或死亡删失移植存活率方面未观察到此类差异。然而，我们观察到接受较大肾脏的受者死亡率增加；这一观察结果与现有文献相矛盾，值得进一步研究。
