Atay Feyza Firat, Taskapan Hulya, Berktas Bayram, Yildirim Okan, Dogan Murat, Piskin Turgut
Nephrology, Inonu University, Malatya, Turkey.
Radiology, Inonu University, Malatya, Turkey.
Transplant Proc. 2019 Sep;51(7):2318-2320. doi: 10.1016/j.transproceed.2019.01.165. Epub 2019 Aug 7.
In healthy individuals, glomerular filtration rate decreases by 1 mL/min/y after a peak level of 125.0 mL/min has been reached in adulthood. Any reduction greater than this is a progressive slope (slope more negative than -1 mL/min/y, stable [-1 to +1]), or an improvable slope if it shows more of an increase, that is, greater than +1.0 mL/min/y). The aim of the study was to determine the factors affecting estimated glomerular filtration rate (eGFR) slope during the first 2 years of renal transplant in patients with negative pretransplant panel-reactive antibody.
The characteristics of 59 renal transplant patients, such as age, sex, etiology, and 2 years of laboratory data, were collected retrospectively. For each patient, the eGFR decline rate (slope) (mL/min-1/1.73 m-1/y-1) was determined by linear regression analysis using all calculated eGFR values over the study period.
Of 59 patients, 7 (11.8%) had a progressive slope, 22 (37.2%) had a stable slope, and 30 (50.8%) had an improvable slope. The first-year mean tacrolimus level was lower in patients with progressive slope than in the patients with stable slope and improvable slope (P < .022). The determinants of eGFR slope in multiple regression analysis were post-transplant hypertension (β = -0.393; P = .002) and the first-year mean tacrolimus level (β = 0.320; P = .01), whereas age, serum albumin, and 2-year mean tacrolimus level did not reach the level of significance.
Keeping tacrolimus levels high in the first year to prevent eGFR declining is important.
在健康个体中，成年后肾小球滤过率在达到峰值125.0 mL/min后，每年下降1 mL/min。任何大于此数值的下降即为进展性斜率（斜率比-1 mL/min/y更负，稳定斜率为[-1至+1]），若显示出更多增加，即大于+1.0 mL/min/y，则为可改善斜率。本研究的目的是确定影响移植前群体反应性抗体阴性的肾移植患者肾移植术后前2年估计肾小球滤过率（eGFR）斜率的因素。
回顾性收集59例肾移植患者的年龄、性别、病因等特征以及2年的实验室数据。对于每位患者，通过线性回归分析，使用研究期间所有计算出的eGFR值来确定eGFR下降率（斜率）（mL/min⁻¹/1.73 m⁻²/y⁻¹）。
59例患者中，7例（11.8%）有进展性斜率，22例（37.2%）有稳定斜率，30例（50.8%）有可改善斜率。进展性斜率患者第一年他克莫司平均水平低于稳定斜率和可改善斜率患者（P <.022）。多因素回归分析中，eGFR斜率的决定因素为移植后高血压（β = -0.393；P =.002）和第一年他克莫司平均水平（β = 0.320；P =.01），而年龄、血清白蛋白和两年他克莫司平均水平未达到显著水平。
在第一年维持较高的他克莫司水平以防止eGFR下降很重要。
