Noya-Mourullo Andrea, Martín-Parada Alejandro, Palacios-Hernández Alberto, Eguiluz-Lumbreras Pablo, Heredero-Zorzo Óscar, García-Gómez Francisco, Álvarez-Ossorio-Fernández José Luis, Álvarez-Ossorio-Rodal Andrea, Márquez-Sánchez Magaly-Teresa, Flores-Fraile Javier, Fraile-Gómez Pilar, Padilla-Fernández Bárbara Yolanda, Lorenzo-Gómez María-Fernanda
Urology Department, University Hospital of Salamanca, 37007 Salamanca, Spain.
Department of Surgery, University of Salamanca, 37007 Salamanca, Spain.
J Pers Med. 2024 Apr 12;14(4):408. doi: 10.3390/jpm14040408.
The protocol for deceased donor kidney transplants has been standardised. The procedure for a living donor has peculiarities derived from the differences in the graft. When a living kidney donor program is implemented, changes occur in both the profile of the kidney transplant candidate and in the postoperative treatments.
To discover whether a living donor program influences the functional outcomes of kidney grafts in a longstanding classical deceased donor kidney transplant program and to identify the factors associated with transplant outcomes.
Retrospective observational multicentre study.
Kidney transplant patients in two urology referral centres for renal transplant in Spain between 1994 and 2019. Groups: TV (living transplant): patients given kidney transplants from living donors ( = 150); TCpre11 (deceased transplant previous to 2011): patients given kidney transplants from deceased donors before the living donor program was implemented ( = 650); and TCpost11 (deceased transplant after 2011): patients given kidney transplants from deceased donors after the living donor program was implemented ( = 500).
Mean age was 55.75 years (18-80 years), higher in TCpre11. There were 493 female patients (37.92%) and 1007 male patients (62.08%). Mean body mass index (BMI) was 26.69 kg/m (17.50-42.78 kg/m), higher in TCpre11. Mean ischemia time was 17.97 h (6-29 h), higher in TCpost11. Median duration of urethral catheter: 8 days (6-98 days), higher in TCpost11. Median duration of double-J ureteral stent: 58 days (24-180 days), higher in TCpost11. Pretransplant UTIs: 17.77%, higher in TCpre11 (25.69%) than in TV (12%), higher in TV (12%) than TCpost11 (9.2%), and higher in TCpre11 (25.69%) than TCpost11 (9.2%). Acute renal rejection in 9.33% of TV, 14.77% of TCpre11, and 9.8% of TCpost11. Multivariate analysis: TCpost11 featured higher BMI, more smoking, and chronic renal failure progression time. Lower use of nonantibiotic prophylaxis to prevent recurrent urinary tract infections, increased duration of urethral catheters due to obstructive problems, and favoured deterioration of kidney function was observed in the deceased donor program. The living donor (LD) program had a strong influence on deceased donor transplants in the prelysis phase. Implementation of a LD program was associated with a decrease in the likelihood of acute rejection in TCpost11 and an increase in the tendency towards normal kidney function.
Implementing living donor transplant programs affects functional outcomes in deceased donor transplants, reducing the probability of acute rejection and increasing the tendency towards normal kidney function. Preventing recurrent urinary tract infections with measures other than antibiotics, smoking cessation, delaying the removal of the double-J stent from the graft, and pre-emptive transplant (transplant prior to dialysis) are associated with improved renal function of the graft.
已故供体肾移植的方案已经标准化。活体供体的程序有其独特之处，这源于移植物的差异。当实施活体肾供体项目时，肾移植候选者的情况以及术后治疗都会发生变化。
探讨在长期的经典已故供体肾移植项目中，活体供体项目是否会影响肾移植的功能结果，并确定与移植结果相关的因素。
回顾性观察性多中心研究。
1994年至2019年间西班牙两个肾脏移植泌尿外科转诊中心的肾移植患者。分组：TV（活体移植）：接受活体供体肾移植的患者（n = 150）；TCpre11（2011年前的已故移植）：在活体供体项目实施前接受已故供体肾移植的患者（n = 650）；以及TCpost11（2011年后的已故移植）：在活体供体项目实施后接受已故供体肾移植的患者（n = 500）。
平均年龄为55.75岁（18 - 80岁），TCpre11组年龄更高。有493名女性患者（37.92%）和1007名男性患者（62.08%）。平均体重指数（BMI）为26.69 kg/m²（17.50 - 42.78 kg/m²），TCpre11组更高。平均缺血时间为17.97小时（6 - 29小时），TCpost11组更高。尿道导管留置时间中位数：8天（6 - 98天），TCpost11组更高。双J输尿管支架留置时间中位数：58天（24 - 180天），TCpost11组更高。移植前尿路感染率：17.77%，TCpre11组（25.69%）高于TV组（12%），TV组（12%）高于TCpost11组（9.2%），TCpre11组（25.69%）高于TCpost11组（9.2%）。TV组急性肾排斥发生率为9.33%，TCpre11组为14.77%，TCpost11组为9.8%。多因素分析：TCpost11组的BMI更高、吸烟更多且慢性肾衰竭进展时间更长。在已故供体项目中观察到预防复发性尿路感染的非抗生素预防措施使用较少、因梗阻问题导致尿道导管留置时间延长以及肾功能恶化倾向增加。活体供体（LD）项目在预分析阶段对已故供体移植有很大影响。LD项目的实施与TCpost11组急性排斥可能性降低以及肾功能趋于正常的趋势增加相关。
实施活体供体移植项目会影响已故供体移植的功能结果，降低急性排斥的概率并增加肾功能趋于正常的趋势。采用抗生素以外的措施预防复发性尿路感染、戒烟、延迟从移植物中取出双J支架以及抢先移植（透析前移植）与移植物肾功能改善相关。
