Truche Anne-Sophie, Trocme Candice, Vergnaud Sabrina, Janbon Bénédicte, Giovannini Diane, Malvezzi Paolo, Moreau-Gaudry Xavier, Rostaing Lionel, Tetaz Rachel
Nephrology Hemodialysis Apheresis, and Kidney Transplantation, Grenoble University Hospital, La Tronche, France; Université Grenoble-Alpes, Grenoble, France.
Department of Biochemistry Toxicology and Pharmacology, Grenoble University Hospital, La Tronche, France.
Transplant Proc. 2019 Dec;51(10):3234-3243. doi: 10.1016/j.transproceed.2019.09.009. Epub 2019 Nov 13.
This study aimed to identify transplantation characteristics and biomarkers that predict outcomes for kidney transplant (KT) patients from donors after circulatory death (DCDs).
Consecutive patients receiving a KT from a DCD in our center between 2014 and 2016 were included; the reference population was recipients with a living donor KT. The urinary tubular injury biomarker-to-creatinine ratio and serum lactate dehydrogenase (LDH) were measured at post-transplant days 1 and 3. The primary outcome was the occurrence of delayed graft function (DGF). Descriptive and receiver operating characteristic analyses were performed.
Forty-one patients were included in the analysis: 15 (36.59%) DCD KTs (9 of which suffered from DGF) and 26 (63.41%) living donor KTs. For the primary endpoint, neutrophil gelatinase-associated lipocalin, N-acetyl-beta-D-glucosaminidase, urinary tubular injury biomarker-to-creatinine ratio, and LDH areas under the curve were 1 and 0.96 (95% confidence interval: 0.84-1.0), 1 and 0.92 (95% confidence interval: 0.73-1.0), respectively. Among the transplant characteristics, only the 30-minute resistive index on the perfusion machine was significantly higher in DCD KTs with DGF vs those without DGF (0.26 mm Hg/mL/min [0.20; 0.32] vs 0.14 mm Hg/mL/min [0.12; 0.16], P = .05). Median 3-month creatinine clearance among DGF DCD KTs was 49 mL/min/1.73 m [IQR: 42; 65] and 65 mL/min/1.73 m [IQR: 62; 66] among DCD KTs without DGF (P = .22).
In the DCD KT population, clinical and biological markers were identified that provided predictive tools for DGF. Thus, systematic measurement of these biomarkers, particularly LDH, could improve the management of kidney graft recipients' immunosuppressive therapy.
本研究旨在确定循环死亡后供体肾移植（KT）患者的移植特征和预测预后的生物标志物。
纳入2014年至2016年在本中心接受DCD供体KT的连续患者；参考人群为活体供体KT受者。在移植后第1天和第3天测量肾小管损伤生物标志物与肌酐的比值以及血清乳酸脱氢酶（LDH）。主要结局为移植肾功能延迟恢复（DGF）的发生。进行描述性分析和受试者工作特征分析。
41例患者纳入分析：15例（36.59%）DCD供体KT（其中9例发生DGF）和26例（63.41%）活体供体KT。对于主要终点，中性粒细胞明胶酶相关脂质运载蛋白、N-乙酰-β-D-氨基葡萄糖苷酶、肾小管损伤生物标志物与肌酐的比值以及LDH的曲线下面积分别为1和0.96（95%置信区间：0.84 - 1.0）、1和0.92（95%置信区间：0.73 - 1.0）。在移植特征中，仅灌注机上的30分钟阻力指数在发生DGF的DCD供体KT中显著高于未发生DGF的患者（0.26 mmHg/mL/min [0.20; 0.32] 对 0.14 mmHg/mL/min [0.12; 0.16]，P = 0.05）。发生DGF的DCD供体KT中3个月时肌酐清除率中位数为49 mL/min/1.73 m² [四分位间距：42; 65]，未发生DGF的DCD供体KT中为65 mL/min/1.73 m² [四分位间距：62; 66]（P = 0.22）。
在DCD供体KT人群中，确定了可为DGF提供预测工具的临床和生物学标志物。因此，系统测量这些生物标志物，尤其是LDH，可改善肾移植受者免疫抑制治疗的管理。
