KDPI 评分中血清肌酐测量的最佳时机对预测尸体供肾移植术后肾功能的研究
Optimal Timing of Serum Creatinine Measurement for KDPI Scoring to Predict Postoperative Renal Function in Deceased Donor Kidney Transplantation.
机构信息
Department of Surgery, Korea University Anam Hospital, Korea University College of Medicine, Seoul, South Korea.
Department of Surgery, Ilsan Paik Hospital, Inje University College of Medicine, Goyang, South Korea.
出版信息
Transplant Proc. 2024 Jul-Aug;56(6):1247-1250. doi: 10.1016/j.transproceed.2024.02.022. Epub 2024 Jul 14.
INTRODUCTION
The widely employed Kidney Donor Profile Index (KDPI) scoring system, designed for assessing deceased donors (DD), plays a pivotal role in predicting graft function post kidney transplantation (KT). Given the dynamic nature of renal function, including serum creatinine (sCr), in managing DDs, it remains uncertain optimal timing to use KDPI for assessing postoperative graft function.
METHODS
In this retrospective review, we assessed 246 DDs who were managed within a donor management program from January 2010 to December 2021. We collected sCr values for KDPI scoring at admission, peak, and last measurements before KT. Recipient data included occurrence of slow graft function (SGF), delayed graft function (DGF), and glomerular filtration rate (GFR) at one-year post-transplantation (1 Y). Using Receiver Operating Characteristic (ROC) and Pearson correlation analyses, we explored correlations of KDPI score (admission, peak, last) with graft function (SGF, DGF, GFR 1 Y).
RESULTS
The average age of DDs and recipients was 49.78 ± 13.37 and 52.54 ± 10.49 years, respectively, with mean KDPI values at admission, peak, and last measurements of 62.36 ± 25.44, 66.94 ± 24.73, and 63.75 ± 25.80. After transplantation, SGF was observed in 81 recipients (32.9%) and DGF in 32 (13.0%). For SGF, the Area Under the Curve (AUC) from ROC analysis were 0.684 (95% CI, 0.615-0.753; P < .001) at admission, 0.691 (0.623-0.759; P < .001) at peak, and 0.697 (0.630-0.765; P < .001) at the last measurement. In predicting DGF, the corresponding AUC values were 0.746 (0.661-0.831; P < .001) at admission, 0.724 (0.637-0.810; P < .001) at peak, and 0.721 (0.643-0.809; P < .001) at the last. Moreover, KDPI scores at all time points-admission, peak, and last-moderately correlated with GFR 1 Y (R = -0.426, -0.423, -0.417).
CONCLUSION
KDPI measurements at all time points, particularly admission, would be more effective in predicting DGF in DDKT.
简介
广泛应用的肾供体评分指数（KDPI）评分系统，专为评估已故供体（DD）而设计，在预测肾移植（KT）后移植物功能方面发挥着关键作用。鉴于肾功能（包括血清肌酐[sCr]）在 DD 管理中的动态性质，KDPI 用于评估术后移植物功能的最佳时机仍不确定。
方法
在这项回顾性研究中，我们评估了 2010 年 1 月至 2021 年 12 月期间在供体管理计划中接受管理的 246 名 DD。我们在入院、峰值和 KT 前最后一次测量时采集了 KDPI 评分的 sCr 值。受者数据包括慢移植物功能（SGF）、延迟移植物功能（DGF）和移植后 1 年（1 Y）的肾小球滤过率（GFR）。使用接收者操作特征（ROC）和皮尔逊相关分析，我们探讨了 KDPI 评分（入院、峰值、最后）与移植物功能（SGF、DGF、GFR 1 Y）的相关性。
结果
DD 和受者的平均年龄分别为 49.78±13.37 岁和 52.54±10.49 岁，入院、峰值和最后测量的平均 KDPI 值分别为 62.36±25.44、66.94±24.73 和 63.75±25.80。移植后，81 名受者（32.9%）出现 SGF，32 名受者（13.0%）出现 DGF。对于 SGF，ROC 分析的曲线下面积（AUC）分别为入院时 0.684（95%CI，0.615-0.753；P<0.001）、峰值时 0.691（0.623-0.759；P<0.001）和最后一次测量时 0.697（0.630-0.765；P<0.001）。在预测 DGF 时，相应的 AUC 值分别为入院时 0.746（0.661-0.831；P<0.001）、峰值时 0.724（0.637-0.810；P<0.001）和最后一次测量时 0.721（0.643-0.809；P<0.001）。此外，KDPI 评分在所有时间点（入院、峰值和最后）与 1 Y 的 GFR 中度相关（R=−0.426、−0.423、−0.417）。
结论
KDPI 在所有时间点（尤其是入院时）的测量值在预测 DDKT 中的 DGF 方面更有效。
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