活体肾移植中预捐献单肾肾小球滤过率预测移植肾功能及供体功能获益

Predonation Single Kidney Glomerular Filtration Rate in Living Kidney Transplantation to Predict Graft Function and Donor Functional Gain.

作者信息

Heitz Morgane, Jouve Thomas, Roustit Matthieu, Terrier Nicolas, Fiard Gaëlle, Charara Stéphane, Janbon Bénédicte, Noble Johan, Giovannini Diane, Bennani Hamza Naciri, Gomez Isabelle, Malvezzi Paolo, Rambeaud Jean-Jacques, Rostaing Lionel, Tetaz Rachel

机构信息

Service de Néphrologie, Hémodialyse, Aphérèses et Transplantation Rénale, CHU Grenoble-Alpes, Grenoble, France.

Service de Néphrologie, Hémodialyse, Aphérèses et Transplantation Rénale, CHU Grenoble-Alpes, Grenoble, France; Faculté de Médecine, Université Grenoble Alpes, Grenoble, France.

出版信息

Transplant Proc. 2020 Apr;52(3):712-721. doi: 10.1016/j.transproceed.2020.01.026. Epub 2020 Mar 9.

DOI:10.1016/j.transproceed.2020.01.026

PMID:32164958

Abstract

BACKGROUND

The 2 main objectives regarding living kidney transplant are to provide optimal graft function and to ensure the safety of donation. Our study hypothesized that the glomerular filtration rate of a single kidney (skGFR), when transplanted, might predict graft function and that the skGFR of the remaining kidney could predict donor functional gain.

METHODS

A prospective monocentric study was conducted at Grenoble-Alpes University Hospital. Twenty couples of donors and recipients were included. Dimercaptosuccinic acid renal scintigraphy and Cr-ethylene-diamine tetra-acetic acid clearance were evaluated predonation to calculate skGFR. All patients had renal function according to Cr-ethylene-diamine tetra-acetic acid clearance at 1 year post transplant to assess graft function and donor functional gain. All donors had normal renal function predonation.

RESULTS

At 1 year post transplant, median glomerular filtration rate of the graft was 50 mL/min/1.73 m (range, 46-56 mL/min/1.73 m) and donor median glomerular filtration rate was 59 mL/min/1.73 m (range, 55-74 mL/min/1.73 m). Median functional gain was 20 mL/min/1.73 m (range, 12-22 mL/min/1.73 m). No statistical correlation was found between skGFR of the transplanted kidney and graft function at 1 year (R = 0.096, P = .7). For the donor, functional gain was not associated with predonation skGFR of the remaining kidney (R = 0.17, P = .5). A statistical difference was found between donor functional gain (18 [SD, 10] mL/min) and recipient gain (delta between skGFR before and after transplant, 7 [SD, 16] mL/min; P = .02).

CONCLUSION

Predonation skGFR of the transplanted kidney had no influence on renal allograft function at 1 year post transplant. Similarly, there was no association between measured skGFR of the remaining kidney and donor functional gain at 1 year.

摘要

背景

活体肾移植的两个主要目标是提供最佳的移植肾功能并确保供体安全。我们的研究假设，移植时单个肾脏的肾小球滤过率（skGFR）可能预测移植肾功能，而剩余肾脏的skGFR可以预测供体的功能获益。

方法

在格勒诺布尔-阿尔卑斯大学医院进行了一项前瞻性单中心研究。纳入了20对供体和受体。在捐献前评估二巯基丁二酸肾闪烁显像和铬-乙二胺四乙酸清除率以计算skGFR。所有患者在移植后1年根据铬-乙二胺四乙酸清除率评估肾功能，以评估移植肾功能和供体功能获益。所有供体在捐献前肾功能正常。

结果

移植后1年，移植肾的肾小球滤过率中位数为50 mL/min/1.73m²（范围为46 - 56 mL/min/1.73m²），供体肾小球滤过率中位数为59 mL/min/1.73m²（范围为55 - 74 mL/min/1.73m²）。功能获益中位数为20 mL/min/1.73m²（范围为12 - 22 mL/min/1.73m²）。移植肾的skGFR与1年后的移植肾功能之间未发现统计学相关性（R = 0.096，P = 0.7）。对于供体，功能获益与剩余肾脏捐献前的skGFR无关（R = 0.17，P = 0.5）。发现供体功能获益（18[标准差，10]mL/min）与受体获益（移植前后skGFR的差值，7[标准差，16]mL/min；P = 0.02）之间存在统计学差异。