小儿尸体供肾移植治疗急性肾损伤的良好临床效果。

Excellent clinical outcomes of renal transplant from pediatric deceased donors with acute kidney injury.

机构信息

Department of Kidney Transplantation, The Second Xiangya Hospital of Central South University, No. 139 Renmin Road, Changsha, 410011, Hunan Province, China.

Clinical Research Center for Organ Transplantation in Hunan Province, Changsha, China.

出版信息

Eur J Med Res. 2023 May 4;28(1):161. doi: 10.1186/s40001-023-01111-9.

DOI:10.1186/s40001-023-01111-9

PMID:37143170

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC10158327/

Abstract

BACKGROUND

The use of kidneys from deceased donors with acute kidney injury (AKI) to expand the donor pool is an ongoing trend. Prior research on the utilization of AKI donor kidneys, especially from pediatric AKI donors, was limited and has been subject to small sample sizes. In this study, we aimed to evaluate the safety and effectiveness of early post-transplantation outcomes in pediatric deceased donors with AKI.

METHODS

This retrospective study compared the clinical results (including delayed graft function [DGF], acute rejection, patient and death-censored graft survival rates and renal function post-transplant) of kidney transplantation from deceased donors who were categorized as pediatric donors and adult donors with or without AKI, as defined by the Kidney Disease: Improving Global Outcomes (KIDGO) criteria, at our center between January 2018 and December 2020.

RESULTS

Of the 740 patients, 154 received kidneys from pediatric donors (with AKI group [n = 41]; without AKI group [n = 113]), and 586 received kidneys from adult donors (with AKI group [n = 218]; without AKI group [n = 368]). The baseline characteristics were similar in both cohorts. No significant difference was observed in 1-year patient survival, death-censored graft survival, or acute rejection between the AKI and non-AKI groups in both the pediatric and adult cohorts. However, compared with those transplanted with adult AKI kidneys, those transplanted with pediatric AKI kidneys showed a superior recovery of allograft function. In pediatric cohorts, no significant difference was found in serum creatinine/estimated glomerular filtration rate (SCr/eGFR) between the AKI and non-AKI groups, even in the first week post-transplant. In contrast, the post-transplant SCr/eGFR level of the AKI group recipients in adult cohorts did not recover to a level statistically similar to that of non-AKI recipients, even at 6-months post-transplant. Nonetheless, AKI kidney recipients were at an increased risk of DGF in both pediatric (34.1% vs. 16.8%) and adult (38.5% vs. 17.4%) cohorts.

CONCLUSIONS

Kidney transplantation from deceased donors with AKI has short-term clinical outcomes comparable to those of non-AKI kidney transplantation. Pediatric AKI kidneys have a superior recovery of allograft function. The transplant community should utilize this donor pool to minimize waiting-list-related mortalities.

摘要

背景

使用患有急性肾损伤（AKI）的已故供者的肾脏来扩大供者库是一种持续的趋势。先前关于 AKI 供者肾脏利用的研究，特别是来自儿科 AKI 供者的研究，受到样本量小的限制。在这项研究中，我们旨在评估 AKI 后儿科已故供者移植后早期的安全性和有效性。

方法

本回顾性研究比较了我院 2018 年 1 月至 2020 年 12 月间，根据肾脏病：改善全球预后（KDIGO）标准，按儿科供者和成人供者、是否伴有 AKI 分类的肾移植的临床结果（包括延迟移植物功能[DGF]、急性排斥反应、患者和死亡censored 移植物存活率以及移植后肾功能）。

结果

在 740 例患者中，有 154 例接受了儿科供者的肾脏（AKI 组[n=41]；无 AKI 组[n=113]），586 例接受了成人供者的肾脏（AKI 组[n=218]；无 AKI 组[n=368]）。两组的基线特征相似。在儿科和成人队列中，AKI 组和非 AKI 组在 1 年患者存活率、死亡 censored 移植物存活率或急性排斥反应方面均无显著差异。然而，与接受成人 AKI 供肾移植者相比，接受儿科 AKI 供肾移植者的同种异体移植物功能恢复更优。在儿科队列中，AKI 组和非 AKI 组在移植后第 1 周的血清肌酐/估算肾小球滤过率（SCr/eGFR）无显著差异。相比之下，成人队列中 AKI 组受者的移植后 SCr/eGFR 水平在移植后 6 个月时仍未恢复到与非 AKI 受者统计学相似的水平。尽管如此，AKI 供肾受者在儿科（34.1% vs. 16.8%）和成人（38.5% vs. 17.4%）队列中均有更高的 DGF 风险。