Division of Nephrology, Department of Medicine, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Bangkok, Thailand.
Renal Immunology and Transplantation Research Unit, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand.
Nephron. 2019;141(4):236-248. doi: 10.1159/000495765. Epub 2019 Jan 11.
Delayed graft function (DGF) could worsen early and long-term outcomes of kidney transplantation (KT). DGF is caused by several pre-transplantation and perioperative factors in both donors and recipients. At present, there are no biomarkers or tests during the immediate post-KT period that can accurately predict the development of DGF.
This prospective study was conducted in deceased donor KT (DDKT) at King Chulalongkorn Memorial Hospital, Thailand. All recipients underwent furosemide stress test (FST) by receiving a single dose of intravenous furosemide, 1.5 mg/kg at 3 h after allograft reperfusion. We determined the correlations between DGF (requiring dialysis within the first week after transplantation) and the values of urine volume recorded hourly after FST until 6 h, the parameters of postoperative dynamic tests, including resistive index (RI) of renal arteries and effective renal plasma flow (ERPF), and urine neutrophil gelatinase-associated lipocalin (NGAL).
Of the 59 total DDKT recipients enrolled, 24 developed DGF. The FST is a more accurate biomarker than urine NGAL, RI of renal arteries, and ERPF in the prediction of DGF. The 4-h urine volume less than 350 mL (FST non-responsive) was the best cut-off value in predicting DGF with 87.5% sensitivity, 82.9% specificity, and 82.5% accuracy. Multiple logistic regression analyses showed an odds ratio of 0.993 (0.986-0.999, p = 0.035) for the 4-h urine volume to predict DGF.
The FST is a simple and accurate biomarker for predicting DGF in early post-KT period. Close monitoring and well prepared dialysis are suggested in patients with urine volume < 350 mL after 4 h of FST. The FST non-responsive patients could be the target for further DGF preventive intervention. ClinicalTrials.gov identifier: NCT03071536.
延迟移植物功能（DGF）可能会使肾移植（KT）的早期和长期结果恶化。DGF 是由供体和受体的几个移植前和围手术期因素引起的。目前，在 KT 后即刻期间没有生物标志物或测试可以准确预测 DGF 的发展。
这项前瞻性研究在泰国朱拉隆功国王纪念医院进行，涉及已故供体 KT（DDKT）。所有受者在同种异体再灌注后 3 小时接受单次静脉注射呋塞米 1.5mg/kg 的速尿刺激试验（FST）。我们确定了 DGF（需要在移植后第一周内进行透析）与 FST 后每小时记录的尿量值之间的相关性，直到 6 小时，术后动态测试的参数，包括肾动脉阻力指数（RI）和有效肾血浆流量（ERPF），以及尿中性粒细胞明胶酶相关脂质运载蛋白（NGAL）。
在 59 例接受 DDKT 的患者中，24 例发生 DGF。FST 是一种比尿 NGAL、肾动脉 RI 和 ERPF 更准确的生物标志物，可预测 DGF。4 小时尿量<350ml（FST 无反应）是预测 DGF 的最佳截断值，具有 87.5%的敏感性、82.9%的特异性和 82.5%的准确性。多变量逻辑回归分析显示，4 小时尿量预测 DGF 的优势比为 0.993（0.986-0.999，p=0.035）。
FST 是预测 KT 后早期 DGF 的一种简单而准确的生物标志物。建议在 FST 后 4 小时尿量<350ml 的患者密切监测并准备好透析。FST 无反应的患者可能是进一步预防 DGF 干预的目标。临床试验注册号：NCT03071536。
