Donnelly Cullan V, Keller Maria, Kayler Liise
Jacobs School of Medicine and Biomedical Sciences, SUNY-University at Buffalo, 955 Main Street, Buffalo, NY 14203, USA.
Department of Surgery, SUNY-University at Buffalo, 100 High Street, Buffalo, NY 14203, USA.
J Clin Med. 2022 Mar 11;11(6):1535. doi: 10.3390/jcm11061535.
Background: The protracted recovery of renal function may be an actionable marker of post-transplant adverse events, but a paucity of data are available to determine if the duration of graft recovery serves to stratify risk. Materials and Methods: Single-center data of adult-isolated deceased-donor kidney transplant (KTX) recipients between 1 July 2015 and 31 December 2018 were stratified by delayed graft function (DGF) duration, defined as time to serum creatinine < 3.0 mg/dL. Results: Of 355 kidney transplants, the time to creatinine < 3.0 mg/dL was 0−3 days among 96 cases (DGF ≤ 3), 4−10 days among 85 cases (DGF4-10), 11−20 days among 93 cases (DGF11-20), and ≥21 days for 81 cases (DGF ≥ 21). DGF ≥ 21 recipients were significantly more likely to be male, non-sensitized, and receive kidneys from donors that were older, with donation after circulatory death, non-mandatory share, hypertensive, higher KDPI, higher terminal creatinine, and longer cold and warm ischemia time. On multivariate analysis, DGF ≥ 21 was associated with a 5.73-fold increased odds of 12-month eGFR < 40 mL/min compared to DGF ≤ 3. Lesser degrees of DGF had similar outcomes. Conclusions: Prolonged DGF lasting over 20 days signifies a substantially higher risk for reduced eGFR at 1 year compared to lesser degrees of DGF, thus serving as a threshold indicator of increased risk.
肾功能的长期恢复可能是移植后不良事件的一个可采取行动的标志物，但缺乏数据来确定移植肾功能恢复的持续时间是否有助于分层风险。材料与方法：对2015年7月1日至2018年12月31日期间成年孤立死亡供体肾移植（KTX）受者的单中心数据，根据移植肾功能延迟（DGF）持续时间进行分层，DGF持续时间定义为血清肌酐降至<3.0mg/dL的时间。结果：在355例肾移植中，96例（DGF≤3）血清肌酐降至<3.0mg/dL的时间为0 - 3天，85例（DGF4 - 10）为4 - 10天，93例（DGF11 - 20）为11 - 20天，81例（DGF≥21）为≥21天。DGF≥21的受者更有可能为男性、非致敏，接受来自年龄较大、循环死亡后捐赠、非强制分配、高血压、KDPI较高、终末期肌酐较高以及冷、热缺血时间较长的供体的肾脏。多因素分析显示，与DGF≤3相比，DGF≥21使12个月时估算肾小球滤过率（eGFR）<40 mL/min的几率增加5.73倍。较轻程度的DGF有相似的结果。结论：与较轻程度的DGF相比，持续超过20天的延长DGF表明1年时eGFR降低的风险显著更高，因此可作为风险增加的阈值指标。
