Kothari Rishi, Tolles Juliana, Adelmann Dieter, Lewis Roger J, Malinoski Darren J, Niemann Claus U
Department of Anesthesia and Perioperative Care, University of California San Francisco, San Francisco, California, USA.
Department of Emergency Medicine, Harbor-University of California Los Angeles Medical Center, Los Angeles, California, USA.
Clin Transplant. 2022 Feb;36(2):e14528. doi: 10.1111/ctr.14528. Epub 2021 Nov 16.
Delayed graft function (DGF) after kidney transplantation is a common occurrence and correlates with poor graft and patient outcomes. Donor characteristics and care are known to impact DGF. We attempted to show the relationship between achievement of specific donor management goals (DMG) and DGF.
This is a retrospective case-control study using data from 14 046 adult kidney donations after brain death from hospitals in 18 organ procurement organizations (OPOs) which were transplanted to adult recipients between 2012 and 2018. Data on DMG compliance and donor, recipient, and ischemia-related factors were used to create multivariable logistic regression models.
The overall rate of DGF was 29.4%. Meeting DMGs for urine output and vasopressor use were associated with decreased risk of DGF. Sensitivity analyses performed with different imputation methods, omitting recipient factors, and analyzing multiple time points yielded largely consistent results.
The development of DMGs continues to show promise in improving outcomes in the kidney transplant recipient population. Studies have already shown increased kidney utilization in smaller cohorts, as well as other organs, and shown decreased rates of DGF. Additional research and analysis are required to assess interactions between meeting DMGs and correlation versus causality in DMGs and DGF.
肾移植后移植肾功能延迟恢复（DGF）很常见，且与移植肾和患者的不良预后相关。已知供体特征和护理会影响DGF。我们试图揭示特定供体管理目标（DMG）的达成与DGF之间的关系。
这是一项回顾性病例对照研究，使用了18个器官获取组织（OPO）所属医院14046例脑死亡后成人肾捐献的数据，这些肾于2012年至2018年间移植给成年受者。关于DMG依从性以及供体、受体和缺血相关因素的数据用于建立多变量逻辑回归模型。
DGF的总体发生率为29.4%。达到尿量和血管升压药使用方面的DMG与DGF风险降低相关。采用不同插补方法、省略受体因素以及分析多个时间点进行的敏感性分析得出了基本一致的结果。
DMG的制定在改善肾移植受者群体的预后方面仍显示出前景。研究已经表明，在较小队列以及其他器官中，肾脏利用率有所提高，DGF发生率降低。需要进一步的研究和分析来评估达成DMG之间的相互作用以及DMG与DGF之间的相关性和因果关系。
