Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan.
Division of Nephrology and Rheumatology, Department of Internal Medicine, Faculty of Medicine, Fukuoka University, Fukuoka, Japan.
Clin Exp Nephrol. 2019 Nov;23(11):1331-1340. doi: 10.1007/s10157-019-01774-x. Epub 2019 Aug 23.
Recently, living-donor kidney transplantation from marginal donors has been increasing. However, a simple prediction model for graft function including preoperative marginal factors is limited. Here, we developed and validated a new prediction model for graft function using preoperative marginal factors in living-donor kidney transplantation.
We retrospectively investigated 343 patients who underwent living-donor kidney transplantation at Kyushu University Hospital (derivation cohort). Low graft function was defined as an estimated glomerular filtration rate of < 45 mL/min/1.73 m at 1 year. A prediction model was developed using a multivariable logistic regression model, and verified using data from 232 patients who underwent living-donor kidney transplantation at Tokyo Women's Medical University Hospital (validation cohort).
In the derivation cohort, 89 patients (25.9%) had low graft function at 1 year. Donor age, donor-estimated glomerular filtration rate, donor hypertension, and donor/recipient body weight ratio were selected as predictive factors. This model demonstrated modest discrimination (c-statistic = 0.77) and calibration (Hosmer-Lemeshow test, P = 0.83). Furthermore, this model demonstrated good discrimination (c-statistic = 0.76) and calibration (Hosmer-Lemeshow test, P = 0.54) in the validation cohort. Furthermore, donor age, donor-estimated glomerular filtration rate, and donor hypertension were strongly associated with glomerulosclerosis and atherosclerotic vascular changes in the "zero-time" biopsy.
This model using four pre-operative variables will be a simple, but useful guide to estimate graft function at 1 year after kidney transplantation, especially in marginal donors, in the clinical setting.
最近，来源于边缘供者的活体供肾移植逐渐增多。然而，包含术前边缘因素的用于预测移植物功能的简单预测模型仍十分有限。本研究旨在建立并验证一个使用活体供肾移植术前边缘因素预测移植物功能的新模型。
我们回顾性调查了在九州大学医院接受活体供肾移植的 343 例患者（推导队列）。将术后 1 年估算肾小球滤过率（eGFR）＜45ml/min/1.73m2定义为低移植物功能。采用多变量逻辑回归模型建立预测模型，并使用在东京女子医科大学医院接受活体供肾移植的 232 例患者的数据进行验证（验证队列）。
在推导队列中，术后 1 年 89 例（25.9%）患者发生低移植物功能。将供者年龄、供者估算肾小球滤过率、供者高血压和供者/受者体重比作为预测因素。该模型显示出适度的区分能力（C 统计量=0.77）和校准能力（Hosmer-Lemeshow 检验，P=0.83）。此外，该模型在验证队列中也具有良好的区分能力（C 统计量=0.76）和校准能力（Hosmer-Lemeshow 检验，P=0.54）。此外，供者年龄、供者估算肾小球滤过率和供者高血压与“零时间”活检中的肾小球硬化和动脉粥样硬化血管改变密切相关。
该模型使用四个术前变量，在临床实践中，尤其是在边缘供者中，将成为预测术后 1 年移植物功能的一种简单但有用的方法。
