Li Yajuan, Wang Bo, Wang Le, Shi Kewei, Zhao Wangcheng, Gao Sai, Chen Jiayu, Ding Chenguang, Du Junkai, Gao Wei
Department of Anesthesiology and Center for Brain Science and Center for Translational Medicine, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China.
Department of Anesthesiology, 521 Hospital of Norinco Group, Xi'an, China.
Front Med (Lausanne). 2022 Aug 12;9:863962. doi: 10.3389/fmed.2022.863962. eCollection 2022.
Delayed graft function (DGF) commonly occurs after kidney transplantation, but no clinical predictors for guiding post-transplant management are available.
Data including demographics, surgery, anesthesia, postoperative day 1 serum cystatin C (S-CysC) level, kidney functions, and postoperative complications in 603 kidney transplant recipients who met the enrollment criteria from January 2017 to December 2018 were collected and analyzed to form the Intention-To-Treat (ITT) set. All perioperative data were screened using the least absolute shrinkage and selection operator. The discrimination, calibration, and clinical effectiveness of the predictor were verified with area under curve (AUC), calibration plot, clinical decision curve, and impact curve. The predictor was trained in Per-Protocol set, validated in the ITT set, and its stability was further tested in the bootstrap resample data.
Patients with DGF had significantly higher postoperative day 1 S-CysC level (4.2 ± 1.2 vs. 2.8 ± 0.9 mg/L; < 0.001), serum creatinine level (821.1 ± 301.7 vs. 554.3 ± 223.2 μmol/L; < 0.001) and dialysis postoperative (74 [82.2%] vs. 25 [5.9%]; < 0.001) compared with patients without DGF. Among 41 potential predictors, S-CysC was the most effective in the parsimonious model, and its diagnostic cut-off value was 3.80 mg/L with the risk score (OR, 13.45; 95% CI, 8.02-22.57; < 0.001). Its specificity and sensitivity indicated by AUC was 0.832 (95% CI, 0.779-0.884; < 0.001) with well fit calibration. S-CysC yielded up to 50% of clinical benefit rate with 1:4 of cost/benefit ratio.
The postoperative day 1 S-CysC level predicts DGF and may be used as a predictor of DGF but warrants further study.
移植肾功能延迟（DGF）在肾移植后普遍发生，但尚无用于指导移植后管理的临床预测指标。
收集并分析了2017年1月至2018年12月期间符合纳入标准的603例肾移植受者的数据，包括人口统计学资料、手术、麻醉、术后第1天血清胱抑素C（S-CysC）水平、肾功能及术后并发症，以形成意向性分析（ITT）集。使用最小绝对收缩和选择算子对所有围手术期数据进行筛选。通过曲线下面积（AUC）、校准图、临床决策曲线和影响曲线验证预测指标的鉴别能力（区分度）、校准度和临床有效性。该预测指标在符合方案集（Per-Protocol set）中进行训练，在ITT集中进行验证，并在自助重采样数据中进一步测试其稳定性。
与未发生DGF的患者相比，发生DGF的患者术后第1天S-CysC水平（4.2±1.2 vs. 2.8±0.9 mg/L；<0.001）、血清肌酐水平（821.1±301.7 vs. 554.3±223.2 μmol/L；<0.001）显著更高，术后透析率也更高（74例[82.2%] vs. 25例[5.9%]；<0.001）。在41个潜在预测指标中，S-CysC在简约模型中最为有效，其诊断截断值为3.80 mg/L，风险评分（OR，13.45；95%CI，8.02-22.57；<0.001）。AUC显示其特异性和敏感性为0.832（95%CI，0.779-0.884；<0.001），校准良好。S-CysC产生高达50%的临床受益率，成本效益比为1:4。
术后第1天S-CysC水平可预测DGF，可能用作DGF的预测指标，但有待进一步研究。
