肾移植受者移植肾功能延迟的严重程度评估。

Evaluation of severity of delayed graft function in kidney transplant recipients.

作者信息

Schrezenmeier Eva, Müller Mia, Friedersdorff Frank, Khadzhynov Dmytro, Halleck Fabian, Staeck Oliver, Dürr Michael, Zhang Kun, Eckardt Kai-Uwe, Budde Klemens, Lehner Lukas J

机构信息

Department of Nephrology and Medical Intensive Care, Charité-Universitätsmedizin Berlin, Berlin, Germany.

Berlin Institute of Health, Berlin, Germany.

出版信息

Nephrol Dial Transplant. 2022 Apr 25;37(5):973-981. doi: 10.1093/ndt/gfab304.

DOI:10.1093/ndt/gfab304

PMID:34665258

Abstract

BACKGROUND

The most common definition of delayed graft function (DGF) relies on dialysis during the first week post-transplant and does not consider DGF severity. The impact of DGF severity on long-term graft outcome remains controversial.

METHODS

We analysed 627 deceased-donor kidney transplant recipients (KTRs) transplanted in 2005-2015 at our centre for DGF severity, associated risk factors and long-term consequences of DGF.

RESULTS

We found 349 (55.7%) KTRs with DGF, which were classified into four groups according to DGF duration (0-1, 2-7, 8-14, >14 days) and were compared with KTR with no DGF. A longer duration of DGF was associated with progressive worsening of 10-year death-censored graft survival {no DGF: 88.3% [95% confidence interval (CI) 82.4-94.2]; 0-1 day: 81.3% [95% CI 68.2-94.4], 2-7 days: 61.5% [95% CI 43.1.1-79.9], 8-14 days: 66.6% [95% CI 47.4-85.8], >14 days: 51.2% [95% CI 33-69.4]; P < 0.001}. In kidneys with a Kidney Donor Profile Index (KDPI) ≥85%, all DGF severity groups demonstrated reduced graft survival. However, in the <85% KDPI kidneys, only >14 days DGF duration showed worse outcomes.

CONCLUSIONS

DGF had a duration-dependent effect on graft survival, which varied depending on the KDPI. Of note, 0- to 1-day DGF showed comparable results to no DGF in the whole cohort.

摘要

背景

移植后延迟肾功能恢复（DGF）最常见的定义依赖于移植后第一周内的透析情况，且未考虑DGF的严重程度。DGF严重程度对移植肾长期预后的影响仍存在争议。

方法

我们分析了2005年至2015年在本中心接受移植的627例死亡供者肾移植受者（KTR）的DGF严重程度、相关危险因素及DGF的长期后果。

结果

我们发现349例（55.7%）KTR发生DGF，根据DGF持续时间（0 - 1天、2 - 7天、8 - 14天、>14天）分为四组，并与未发生DGF的KTR进行比较。DGF持续时间越长，10年死亡删失移植肾存活率逐渐下降{未发生DGF：88.3%[95%置信区间（CI）82.4 - 94.2]；0 - 1天：81.3%[95%CI 68.2 - 94.4]，2 - 7天：61.5%[95%CI 43.1 - 79.9]，8 - 14天：66.6%[95%CI 47.4 - 85.8]，>14天：51.2%[95%CI 33 - 69.4]；P < 0.001}。在肾脏捐赠者特征指数（KDPI）≥85%的肾脏中，所有DGF严重程度组的移植肾存活率均降低。然而，在KDPI < 85%的肾脏中，只有DGF持续时间>14天的显示出更差的结果。