肾移植中供受者体型不匹配的影响。

The implications of donor-recipient size mismatch in renal transplantation.

作者信息

Kostakis Ioannis D, Karydis Nikolaos, Kassimatis Theodoros, Kessaris Nicos, Loukopoulos Ioannis

机构信息

Department of Transplantation, Guy's Hospital, Guy's and St Thomas' NHS Foundation Trust, London, UK.

Department of HPB Surgery and Liver Transplantation, Royal Free Hospital, Royal Free London NHS Foundation Trust, London, NW3 2QG, UK.

出版信息

J Nephrol. 2021 Dec;34(6):2037-2051. doi: 10.1007/s40620-021-01050-w. Epub 2021 May 25.

DOI:10.1007/s40620-021-01050-w

PMID:34033003

Abstract

INTRODUCTION

Transplanting kidneys small for recipient's size results in inferior graft function. Body surface area (BSA) is related to kidney size. We used the BSA index (BSAi) (Donor BSA/Recipient BSA) to assess whether the renal graft size is sufficient for the recipient.

METHODS

We included 26,223 adult single kidney transplants (01/01/2007-31/12/2019) from the UK Transplant Registry. We divided renal transplants into groups: BSAi ≤ 0.75, 0.75 < BSA ≤ 1, 1 < BSAi ≤ 1.25, BSAi > 1.25. We compared delayed graft function rates, primary non-function rates and graft survival among them. (Reference category: BSAi ≤ 0.75).

RESULTS

Cases with BSAi ≤ 0.75 had the highest delayed graft function rates in living-donor renal transplants (11.1%) (0.75 < BSAi ≤ 1: OR = 0.59, 95% CI = 0.32-1.1, p = 0.095, 1 < BSAi ≤ 1.25: OR = 0.46, 95% CI = 0.23-0.89, p = 0.022, BSAi > 1.25: OR = 0.32, 95% CI = 0.13-0.77, p = 0.011) and in renal transplants from donors after brain death (26.2%) (0.75 < BSAi ≤ 1: OR = 0.72, 95% CI = 0.55-0.96, p = 0.024, 1 < BSAi ≤ 1.25: OR = 0.62, 95% CI = 0.47-0.83, p = 0.001, BSAi > 1.25: OR = 0.65, 95% CI = 0.47-0.9, p = 0.01). There were no significant differences in renal transplants from donors after circulatory death regarding delayed graft function rates (~ 40% in all groups). Graft survival was similar among BSAi groups in renal transplants from living donors and donors after brain death. Renal transplants from donors after circulatory death with BSAi ≤ 0.75 had the shortest graft survival (0.75 < BSAi ≤ 1: HR = 0.55, 95% CI = 0.41-0.74, p < 0.001, 1 < BSAi ≤ 1.25: HR = 0.48, 95% CI = 0.35-0.66, p < 0.001, BSAi > 1.25: HR = 0.45, 95% CI = 0.31-0.66, p < 0.001). Ten-year graft survival rate was 58.4% for renal transplants from donors after circulatory death with BSAi ≤ 0.75.

CONCLUSIONS

Delayed graft function risk is higher in renal transplants with BSAi ≤ 0.75 coming from living donors and donors after brain death. Graft survival is greatly reduced in renal transplants from donors after circulatory death with BSAi ≤ 0.75.

摘要

引言

将尺寸相对受者较小的肾脏进行移植会导致移植肾功能较差。体表面积（BSA）与肾脏大小相关。我们使用体表面积指数（BSAi）（供体BSA/受者BSA）来评估肾移植的大小对于受者来说是否足够。

方法

我们纳入了英国移植登记处26223例成人单肾移植病例（2007年1月1日至2019年12月31日）。我们将肾移植分为几组：BSAi≤0.75、0.75＜BSA≤1、1＜BSAi≤1.25、BSAi＞1.25。我们比较了它们之间的移植肾功能延迟恢复率、原发性无功能率和移植物存活率。（参考类别：BSAi≤0.75）。

结果

在活体供肾移植中，BSAi≤0.75的病例移植肾功能延迟恢复率最高（11.1%）（0.75＜BSAi≤1：OR = 0.59，95%CI = 0.32 - 1.1，p = 0.095；1＜BSAi≤1.25：OR = 0.46，95%CI = 0.23 - 0.89，p = 0.022；BSAi＞1.25：OR = 0.32，95%CI = 0.13 - 0.77，p = 0.011），在脑死亡后供体的肾移植中也是如此（26.2%）（0.75＜BSAi≤1：OR = 0.72，95%CI = 0.55 - 0.96，p = 0.024；1＜BSAi≤1.25：OR = 0.62，95%CI = 0.47 - 0.83，p = 0.001；BSAi＞1.25：OR = 0.65，95%CI = 0.47 - 0.9，p = 0.01）。在循环死亡后供体的肾移植中，移植肾功能延迟恢复率在各组间无显著差异（所有组均约为40%）。在活体供体和脑死亡后供体的肾移植中，各BSAi组间的移植物存活率相似。循环死亡后供体的肾移植中，BSAi≤0.75的移植物存活率最短（0.75＜BSAi≤1：HR = 0.55，95%CI = 0.41 - 0.74，p＜0.001；1＜BSAi≤1.25：HR = 0.48，95%CI = 0.35 - 0.66，p＜0.001；BSAi＞1.25：HR = 0.45，95%CI = 0.31 - 0.66，p＜0.001）。循环死亡后供体的肾移植中，BSAi≤0.75的10年移植物存活率为58.4%。