Aceto Paola, Perilli Valter, Luca Ersilia, Salerno Maria Paola, Punzo Giovanni, Ceaichisciuc Ina, Cataldo Andrea, Lai Carlo, Citterio Franco, Sollazzi Liliana
From the Department of Anaesthesiology and Intensive Care Medicine, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy.
Exp Clin Transplant. 2019 Oct;17(5):575-579. doi: 10.6002/ect.2018.0225. Epub 2019 Feb 22.
Delayed graft function is a frequent complication in deceased-donor kidney transplant, with an incidence ranging from 10% to 50% among different centers; it is also associated with lower graft survival. In this study, we aimed to identify risk factors for delayed graft function, particularly those associated with perioperative management (including cold ischemia time) and nonmodifiable recipient- and donor-related factors. The effects of delayed graft function on graft and patient outcomes were also evaluated.
Our retrospective analyses included 125 adult patients who underwent deceased-donor kidney transplant. Delayed graft function was diagnosed if at least 1 dialysis treatment was required during the first week posttransplant according to Perico's definition.
Prevalence of delayed graft function was 30.4% (n = 38). Cold ischemia time was significantly prolonged in patients with delayed graft function compared with those without it. Multivariate regression showed that cold ischemia time was the only predictor of delayed graft function. A cutoff of 9 hours and 12 minutes was found as a limit beyond which delayed graft function occurred (sensitivity = 90%; specificity = 29%; area under the curve = 0.68). Greater donor and recipient age and longer pretransplant dialysis time in recipients were associated with occurrence of delayed graft function. In patients with delayed graft function, hospital stay duration was significantly greater and 1-year graft survival was significantly lower.
Efforts should be focused on limiting cold ischemia time and associated injury to reduce occurrence of delayed graft function and consequently improve long-term graft survival in kidney transplant recipients. Optimization of posttransplant renal function with the help of new technologies, such as pulsatile perfusion, could be crucial for minimization of cold ischemia time.
移植肾功能延迟是尸体供肾移植中常见的并发症，不同中心的发生率在10%至50%之间；它还与移植肾存活率较低有关。在本研究中，我们旨在确定移植肾功能延迟的危险因素，特别是那些与围手术期管理（包括冷缺血时间）以及不可改变的受者和供者相关因素有关的危险因素。我们还评估了移植肾功能延迟对移植肾和患者结局的影响。
我们的回顾性分析纳入了125例接受尸体供肾移植的成年患者。根据佩里科的定义，如果在移植后第一周内至少需要进行1次透析治疗，则诊断为移植肾功能延迟。
移植肾功能延迟的发生率为30.4%（n = 38）。与未发生移植肾功能延迟的患者相比，发生移植肾功能延迟的患者冷缺血时间显著延长。多因素回归分析显示，冷缺血时间是移植肾功能延迟的唯一预测因素。发现9小时12分钟为一个临界值，超过此值会发生移植肾功能延迟（敏感性 = 90%；特异性 = 29%；曲线下面积 = 0.68）。供者和受者年龄较大以及受者移植前透析时间较长与移植肾功能延迟的发生有关。在发生移植肾功能延迟的患者中，住院时间显著延长，1年移植肾存活率显著降低。
应致力于限制冷缺血时间及相关损伤，以减少移植肾功能延迟的发生，从而提高肾移植受者的长期移植肾存活率。借助搏动灌注等新技术优化移植后肾功能，对于最大限度缩短冷缺血时间可能至关重要。
