扩展标准供体与标准供体肾脏移植受者的延迟移植物功能与移植物丢失相关：一项回顾性、多中心、观察队列研究。
Delayed graft function is correlated with graft loss in recipients of expanded-criteria rather than standard-criteria donor kidneys: a retrospective, multicenter, observation cohort study.
机构信息
Organ Transplantation Research Institution, Division of Kidney Transplantation, Department of Surgery, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong 510530, China.
Department of Renal Transplantation, The Third Affiliated Hospital, Guangzhou Medical University, Guangzhou, Guangdong 510530, China.
出版信息
Chin Med J (Engl). 2020 Mar 5;133(5):561-570. doi: 10.1097/CM9.0000000000000666.
BACKGROUND
Although the use of expanded-criteria donors (ECDs) alleviates the problem of organ shortage, it significantly increases the incidence of delayed graft function (DGF). DGF is a common complication after kidney transplantation; however, the effect of DGF on graft loss is uncertain based on the published literature. Hence, the aim of this study was to determine the relationship between DGF and allograft survival.
METHODS
We conducted a retrospective, multicenter, observation cohort study. A total of 284 deceased donors and 541 recipients between February 2012 and March 2017 were included. We used logistic regression analysis to verify the association between clinical parameters and DGF, and Cox proportional hazards models were applied to quantify the hazard ratios of DGF for kidney graft loss.
RESULTS
Among the 284 deceased donors, 65 (22.8%) donors were ECD. Of the 541 recipients, 107 (19.8%) recipients developed DGF, and this rate was higher with ECD kidneys than with standard-criteria donor (SCD) kidneys (29.2% vs. 17.1%; P = 0.003). The 5-year graft survival rate was not significantly different between SCD kidney recipients with and without DGF (95.8% vs. 95.4%; P = 0.580). However, there was a significant difference between ECD kidney recipients with and without DGF (71.4% vs. 97.6%; P = 0.001), and the adjusted hazard ratio (HR) for graft loss for recipients with DGF was 1.885 (95% confidence interval [CI] = 1.305-7.630; P = 0.024). Results showed that induction therapy with anti-thymocyte globulin was protective against DGF (odds ratio = 0.359; 95% CI = 0.197-0.652; P = 0.001) with all donor kidneys and a protective factor for graft survival (HR = 0.308; 95% CI = 0.130-0.728; P = 0.007) with ECD kidneys.
CONCLUSION
DGF is an independent risk factor for graft survival in recipients with ECD kidneys, but not SCD kidneys.
背景
尽管使用扩展标准供者（ECD）缓解了器官短缺问题，但显著增加了延迟移植物功能障碍（DGF）的发生率。DGF 是肾移植后的常见并发症；然而，根据已发表的文献，DGF 对移植物丢失的影响尚不确定。因此，本研究旨在确定 DGF 与同种异体移植物存活之间的关系。
方法
我们进行了一项回顾性、多中心、观察队列研究。共纳入 2012 年 2 月至 2017 年 3 月期间的 284 名已故供者和 541 名受者。我们使用逻辑回归分析验证了临床参数与 DGF 之间的关联，并应用 Cox 比例风险模型量化了 DGF 对肾移植物丢失的风险比。
结果
在 284 名已故供者中，65 名（22.8%）供者为 ECD。在 541 名受者中，107 名（19.8%）受者发生 DGF，ECD 肾脏的发生率高于标准供者（SCD）肾脏（29.2% vs. 17.1%；P=0.003）。SCD 肾移植受者中有无 DGF 的 5 年移植物存活率无显著差异（95.8% vs. 95.4%；P=0.580）。然而，有 DGF 的 ECD 肾移植受者与无 DGF 的受者之间存在显著差异（71.4% vs. 97.6%；P=0.001），DGF 受者的移植物丢失调整后的风险比（HR）为 1.885（95%置信区间[CI]为 1.305-7.630；P=0.024）。结果表明，抗胸腺细胞球蛋白诱导治疗对所有供者肾脏的 DGF 具有保护作用（比值比[OR]=0.359；95%CI 为 0.197-0.652；P=0.001），对移植物存活具有保护作用（HR=0.308；95%CI 为 0.130-0.728；P=0.007）。
结论
DGF 是 ECD 肾移植受者移植物存活的独立危险因素，但不是 SCD 肾移植受者的危险因素。
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