Scurt Florian G, Ernst Angela, Hammoud Ben, Wassermann Tamara, Mertens Peter R, Schwarz Anke, Becker Jan U, Chatzikyrkou Christos
University Clinic for Nephrology and Hypertension, Diabetology and Endocrinology, Medical Faculty, Otto-von Guericke University Magdeburg, Magdeburg, Germany.
Institute of Medical Statistics and Bioinformatics, University of Cologne, Cologne, Germany.
Nephrology (Carlton). 2022 Dec;27(12):973-982. doi: 10.1111/nep.14108. Epub 2022 Sep 20.
Predicting outcome after transplantation of marginal kidneys is a challenging task. Donor creatinine or estimated glomerular filtration rate (eGFR) are integral components of the respective risk scores. However, there is uncertainty on which of their values obtained successively during procurement is the most suitable.
This is a retrospective study of 221 adult brain death donors with marginal kidneys, transplanted in 223 recipients. We applied logistic regression analysis to investigate the association between initial (at hospital admission), nadir (lowest), zenith (highest) and terminal (at recovery) donor eGFR with primary non-function (PNF), delayed graft function (DGF), 3- and 12-month graft function and 1- and 3-year patient- and death-censored graft survival.
In the multivariate analysis, admission, terminal, and the lowest donor eGFR could most accurately predict DGF. The respective ORs [95% CI] were: 0.875 [0.771-0.993], 0.818 [95% CI: 0.726-0.922] and 0.793 [0.689-0.900]. Although not being significant for DGF (OR 0.931 [95% CI: 0.817-1.106]), the highest eGFR was the best predictor of 3-month graft function (adjusted b coefficient 1.161 [95% CI: 0.355-1.968]). Analysis of primary nonfunction showed that determination of initial and the highest eGFR proved to be the best predictors. The respective ORs [95% CI] were: 0.804 [0.667-0.968] and 0.750 [0.611-0.919]. There were no differences in the risk associations of each of the four eGFR recordings with patient- and graft survival.
The various eGFR recordings determined during the procurement process of marginal donors can predict PNF, DGF and 3- and 12-month graft function. Regarding short-term patient- and graft survival, there appears to be impacted by recipient factors rather than donor kidney function.
预测边缘性肾脏移植后的结果是一项具有挑战性的任务。供体肌酐或估计肾小球滤过率（eGFR）是各自风险评分的重要组成部分。然而，在获取过程中相继获得的这些值中，哪一个最适合仍存在不确定性。
这是一项对221例边缘性肾脏的成年脑死亡供体进行的回顾性研究，这些供体被移植给了223例受者。我们应用逻辑回归分析来研究初始（入院时）、最低点（最低值）、最高点（最高值）和末期（恢复时）供体eGFR与原发性无功能（PNF）、移植肾功能延迟恢复（DGF）、3个月和12个月时的移植肾功能以及1年和3年时的患者及死亡截尾移植肾存活率之间的关联。
在多变量分析中，入院时、末期和最低的供体eGFR能够最准确地预测DGF。各自的比值比[95%置信区间]为：0.875[0.771 - 0.993]、0.818[95%置信区间：(此处原文有误，应为0.726 - 0.922)]和0.793[0.689 - 0.900]。尽管最高eGFR对DGF不具有显著性（比值比0.931[95%置信区间：0.817 - 1.106]），但它是3个月时移植肾功能的最佳预测指标（调整后的b系数为1.161[95%置信区间：0.355 - 1.968]）。原发性无功能分析表明，初始和最高eGFR的测定被证明是最佳预测指标。各自的比值比[95%置信区间]为：0.804[0.667 - 0.968]和0.750[0.611 - 0.919]。四个eGFR记录中的每一个与患者及移植肾存活率的风险关联均无差异。
在边缘性供体获取过程中测定的各种eGFR记录能够预测PNF、DGF以及3个月和12个月时的移植肾功能。关于短期患者及移植肾存活率，似乎受受者因素而非供体肾功能的影响。
