Division of Renal Surgery and Transplantation, Department of Urology, Jichi Medical University Hospital, Tochigi, Japan.
Department of Urology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.
Int J Urol. 2022 Feb;29(2):114-120. doi: 10.1111/iju.14726. Epub 2021 Oct 11.
To evaluate the relationship between the creatinine reduction ratio between postoperative days 1 and 2 and post-transplantation clinical outcomes after living donor kidney transplantation.
Clinical data of patients who underwent living donor kidney transplantation at Jichi Medical University Hospital, Tochigi, Japan, between 2006 and 2019 were retrieved. The creatinine reduction ratio between postoperative days 1 and 2 was calculated based on the formula: (Cre1 - Cre2) × 100/Cre1; patients were then classified into either the slow graft function (creatinine reduction ratio between postoperative days 1 and 2 ≤30%) or immediate graft function (creatinine reduction ratio between postoperative days 1 and 2 >30%) group. We carried out the log-rank test and multivariate Cox proportional hazards regression analyses to assess graft survival and rejection-free survival, and the unpaired t-test and multivariate linear regression to assess post-transplantation estimated glomerular filtration rates. Multivariate analyses used age, sex, dialysis duration, ABO compatibility, donor-specific antibody positivity and medically complex living donors as explanatory variables.
Of the 272 patients, 30 and 242 were in the slow graft function and immediate graft function groups, respectively. Multivariate Cox proportional hazards regression analyses showed a significantly higher incidence of overall and death-censored graft loss in the slow graft function group than the immediate graft function group. The frequency of rejection after 1 week post-transplantation did not differ within the groups. Post-transplantation estimated glomerular filtration rates tended to decline earlier in the slow graft function group than in the immediate graft function group; however, the difference was not statistically significant.
The creatinine reduction ratio between postoperative days 1 and 2 could potentially predict long-term outcomes after living donor kidney transplantation. Using the creatinine reduction ratio between postoperative days 1 and 2 and other conventional indicators might allow accurate risk classification and appropriate therapeutic interventions.
评估术后第 1 天和第 2 天之间的肌酐清除率比值与活体供肾移植后移植后临床结局之间的关系。
检索了 2006 年至 2019 年在日本筑波大学医院接受活体供肾移植的患者的临床数据。根据公式计算术后第 1 天和第 2 天之间的肌酐清除率比值：（Cre1-Cre2）×100/Cre1；然后将患者分为慢肾功能恢复组（术后第 1 天和第 2 天之间的肌酐清除率比值≤30%）和即刻肾功能恢复组（术后第 1 天和第 2 天之间的肌酐清除率比值>30%）。我们进行了对数秩检验和多变量 Cox 比例风险回归分析，以评估移植物存活率和无排斥存活率，并进行了独立样本 t 检验和多变量线性回归，以评估移植后估算的肾小球滤过率。多变量分析使用年龄、性别、透析时间、ABO 相容性、供体特异性抗体阳性和医学上复杂的活体供者作为解释变量。
在 272 名患者中，30 名和 242 名分别在慢肾功能恢复组和即刻肾功能恢复组。多变量 Cox 比例风险回归分析显示，慢肾功能恢复组的总移植物丢失和死亡相关移植物丢失发生率显著高于即刻肾功能恢复组。两组内移植后 1 周内排斥反应的频率没有差异。移植后估算的肾小球滤过率在慢肾功能恢复组比即刻肾功能恢复组更早下降；然而，差异无统计学意义。
术后第 1 天和第 2 天之间的肌酐清除率比值可能可以预测活体供肾移植后的长期结局。使用术后第 1 天和第 2 天之间的肌酐清除率比值和其他常规指标可能允许进行准确的风险分类和适当的治疗干预。
