Laboratory of Experimental Surgery and Surgical Research N.S. Christeas, Athens University Medical School, National and Kapodistrian University of Athens, Greece.
Laboratory of Experimental Surgery and Surgical Research N.S. Christeas, Athens University Medical School, National and Kapodistrian University of Athens, Greece.
Transplant Rev (Orlando). 2019 Jul;33(3):145-153. doi: 10.1016/j.trre.2019.03.003. Epub 2019 Mar 29.
Delayed graft function represents a major complication of kidney transplantation, leading to high rates of short and long-term morbidity. The aim of the present meta-analysis is to assess the role of renal resistive index measurement in the post-transplant period and evaluate its efficacy in the prediction of delayed graft function.
Medline, Scopus, Cochrane Central Register of Controlled Trials CENTRAL, Clinicaltrials.gov and Google Scholar databases were systematically searched. Statistical analysis was performed with Review Manager 5.3, R 3.4.3 and Open Meta-Analyst software.
Fourteen studies were included with a total of 2741 kidney recipients. Patients with delayed graft function presented significantly higher rates of elevated renal resistive index (Odds Ratio: 1.96, 95% CI: [1.37, 2.81]). Also, renal resistive index values were significantly higher in patients with delayed graft function compared both to those with slow (Mean Difference: 0.04, 95% CI: [0.01, 0.07]) and immediate (Mean Difference: 0.10, 95% CI: [0.07, 0.12]) graft function. The pooled sensitivity for the detection of delayed graft function was estimated at 47.2% (95% CI: [30.9, 64.2]), the specificity at 69.3% (95% CI: [54.1, 81.2]) and the area under the curve at 0.613.
The present meta-analysis suggests the promising role of renal resistive index evaluation early after kidney transplantation, since its high values were significantly associated with higher incidence of delayed graft function. Future large-scale studies should define the most appropriate cut-off value and should incorporate renal resistive index in combined models in order to achieve optimal predictive accuracy.
移植肾功能延迟恢复是肾移植的主要并发症之一，导致短期和长期发病率较高。本荟萃分析的目的是评估移植后肾阻力指数测量在预测移植肾功能延迟恢复中的作用。
系统检索了 Medline、Scopus、Cochrane 中央对照试验注册中心（CENTRAL）、Clinicaltrials.gov 和 Google Scholar 数据库。使用 Review Manager 5.3、R 3.4.3 和 Open Meta-Analyst 软件进行统计分析。
共纳入 14 项研究，共 2741 例肾移植受者。延迟恢复的患者肾阻力指数升高的发生率明显较高（优势比：1.96，95%置信区间：[1.37，2.81]）。此外，与肾功能恢复缓慢（平均差异：0.04，95%置信区间：[0.01，0.07]）和即刻（平均差异：0.10，95%置信区间：[0.07，0.12]）相比，延迟恢复的患者的肾阻力指数值也明显更高。检测延迟恢复的灵敏度估计值为 47.2%（95%置信区间：[30.9，64.2]），特异性为 69.3%（95%置信区间：[54.1，81.2]），曲线下面积为 0.613。
本荟萃分析表明，肾阻力指数评估在肾移植后早期具有良好的应用前景，因为其高值与延迟恢复的发生率较高显著相关。未来的大规模研究应确定最合适的截断值，并应将肾阻力指数纳入联合模型，以实现最佳预测准确性。
