Jun Junseok, Park Kyungho, Lee Hyun Suk, Lee Kyo Won, Lee Jung Eun, Park Jae Berm, Kim Kyunga, Huh Wooseong, Kim Yoon-Goo, Kim Dae Joong, Jang Hye Ryoun
Division of Nephrology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
Kidney Res Clin Pract. 2022 Nov;41(6):707-716. doi: 10.23876/j.krcp.21.246. Epub 2022 Jul 19.
Proteinuria is associated with poor allograft and patient survival in kidney transplant recipients. However, the clinical relevance of spot urine protein-to-creatinine ratio (PCR) or albumin-to-creatinine ratio (ACR) as predictors of renal outcomes during the early postoperative period following kidney transplantation (KT) has not been determined.
This single-center retrospective cohort study included 353 kidney transplant recipients who underwent KT between 2014 and 2017 and were followed up for more than 3 years. Among them, 186 and 167 recipients underwent living donor KT and deceased donor KT, respectively. The PCR and ACR were measured during the immediate postoperative period (within 7 days postoperatively), before discharge (2-3 weeks postoperatively), and 3-6 months postoperatively.
The median age of the patients was 51 years (interquartile range, 43-59 years), and 62.9% were male. An immediate postoperative PCR of ≥1 mg/mg was associated with old age, diabetes mellitus, high systolic blood pressure, delayed graft function, and donor factors (deceased donor KT, old age, and high serum creatinine concentrations). The PCR and ACR 3 to 6 months posttransplant were inversely associated with the estimated glomerular filtration rate at 1 year posttransplant. Deceased donor KT recipients with immediate postoperative PCR of ≥3 mg/mg showed a greater incidence of delayed graft function and lower estimated glomerular filtration rate before discharge than those with immediate postoperative PCR of <3 mg/mg.
Early postoperative proteinuria is a useful biomarker to predict early renal outcomes after KT.
蛋白尿与肾移植受者的移植肾及患者生存情况不佳相关。然而，在肾移植（KT）术后早期，随机尿蛋白肌酐比值（PCR）或白蛋白肌酐比值（ACR）作为肾脏预后预测指标的临床相关性尚未明确。
这项单中心回顾性队列研究纳入了353例在2014年至2017年间接受KT并随访超过3年的肾移植受者。其中，186例和167例受者分别接受了活体供肾KT和尸体供肾KT。在术后即刻（术后7天内）、出院前（术后2 - 3周）以及术后3 - 6个月测量PCR和ACR。
患者的中位年龄为51岁（四分位间距，43 - 59岁），62.9%为男性。术后即刻PCR≥1mg/mg与高龄、糖尿病、高收缩压、移植肾功能延迟及供体因素（尸体供肾KT、高龄和高血清肌酐浓度）相关。移植后3至6个月的PCR和ACR与移植后1年的估计肾小球滤过率呈负相关。术后即刻PCR≥3mg/mg的尸体供肾KT受者比术后即刻PCR＜3mg/mg的受者移植肾功能延迟发生率更高，出院前估计肾小球滤过率更低。
术后早期蛋白尿是预测KT后早期肾脏预后的有用生物标志物。
