供体肾移植中延迟移植物功能的持续时间及其对移植物结局的影响。

Duration of delayed graft function and its impact on graft outcomes in deceased donor kidney transplantation.

机构信息

Division of Nephrology, Mayo Clinic Hospital, 5777 East Mayo Blvd, Phoenix, AZ, 85054, USA.

Department of Surgery, Mayo Clinic, 5777 East Mayo Blvd, Phoenix, AZ, 85054, USA.

出版信息

BMC Nephrol. 2022 Apr 19;23(1):154. doi: 10.1186/s12882-022-02777-9.

DOI:10.1186/s12882-022-02777-9

PMID:35440023

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC9017045/

Abstract

BACKGROUND

There is controversy regarding the impact of delayed graft function (DGF) on kidney transplant outcomes. We hypothesize that the duration of DGF, rather than DGF itself, is associated with long-term kidney graft function.

METHODS

We analyzed all deceased donor kidney transplants (DDKT) done at our center between 2008 to 2020. We determined factors associated with DGF duration. DGF duration was assessed at three 14-day intervals: < 14 DGF days, 14-27 DGF days, > 28 DGF days. We studied the impact of DGF duration on survival and graft function and resource utilization, including hospital length of stay and readmissions.

RESULTS

1714 DDKT recipients were included, 59.4% (n = 1018) had DGF. The median DGF duration was 10 days IQR (6,15). The majority of recipients (95%) had resolution of DGF within 28 days. Donor factors associated with DGF days were longer cold ischemia time, donor on inotropes, older age, donation after circulatory death, higher terminal creatinine, and hypertension. Recipient factors associated with increased DGF duration included male sex, length on dialysis before transplant, and higher body mass index. There were no differences in acute rejection events or interstitial fibrosis progression by 4 months when comparing DGF days. The median length of stay was 3 days. However, readmissions increased with increasing DGF duration. Death-censored graft survival was not associated with the length of DGF except when DGF lasted > 28 days.

CONCLUSIONS

Inferior graft survival was observed only in recipients of DDKT with DGF lasting beyond 28 days. DGF lasting < 28 days had no impact on graft survival. Duration of DGF, rather than DGF itself, is associated with graft survival.

TRIAL REGISTRATION

Retrospective study approved by Mayo Clinic IRB number ID: 20-011561.

摘要

背景

关于延迟移植物功能（DGF）对肾移植结局的影响存在争议。我们假设，DGF 的持续时间而不是 DGF 本身与长期肾移植物功能有关。

方法

我们分析了 2008 年至 2020 年间在我们中心进行的所有已故供体肾移植（DDKT）。我们确定了与 DGF 持续时间相关的因素。DGF 持续时间在三个 14 天间隔内进行评估：<14 天 DGF 天、14-27 天 DGF 天、>28 天 DGF 天。我们研究了 DGF 持续时间对生存和移植物功能以及资源利用的影响，包括住院时间和再入院。

结果

纳入 1714 例 DDKT 受者，59.4%（n=1018）有 DGF。DGF 持续时间的中位数为 10 天 IQR（6，15）。大多数受者（95%）在 28 天内解决了 DGF。与 DGF 天数相关的供体因素包括较长的冷缺血时间、供体使用正性肌力药、年龄较大、循环死亡后捐献、较高的终末期肌酐和高血压。与 DGF 持续时间增加相关的受者因素包括男性、移植前透析时间较长和较高的体重指数。在比较 DGF 天数时，4 个月时急性排斥反应事件或间质纤维化进展没有差异。中位住院时间为 3 天。然而，随着 DGF 持续时间的增加，再入院人数增加。除 DGF 持续时间超过 28 天外，死亡校正移植物存活率与 DGF 长度无关。DGF 持续时间<28 天对移植物存活率没有影响。DGF 的持续时间而不是 DGF 本身与移植物存活率有关。