供体急性肾损伤的严重程度是否会影响肾移植后的结果？

Does Severity of Donor Acute Kidney Injury Influence Outcomes Following Kidney Transplantation?

机构信息

Department of Surgery, Wake Forest University School of Medicine, Winston-Salem, USA.

Department of Surgery, Section of Transplantation, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA.

出版信息

Clin Transplant. 2024 Aug;38(8):e15425. doi: 10.1111/ctr.15425.

DOI:10.1111/ctr.15425

PMID:39113644

Abstract

INTRODUCTION

The study purpose was to review retrospectively our single-center experience transplanting kidneys from deceased donors (DD) with acute kidney injury (AKI) according to terminal serum creatinine (tSCr) level.

METHODS

AKI kidneys were defined by a doubling of the DD's admission SCr and a tSCr ≥ 2.0 mg/dL.

RESULTS

From 1/07 to 11/21, we transplanted 236 AKI DD kidneys, including 100 with a tSCr ≥ 3.0 mg/dL (high SCr AKI group, mean tSCr 4.2 mg/dL), and the remaining 136 from DDs with a tSCr of 2.0-2.99 mg/dL (lower SCr AKI group, mean tSCr 2.4 mg/dL). These two AKI groups were compared to 996 concurrent control patients receiving DD kidneys with a tSCr < 1.0 mg/dL. Mean follow-up was 69 months. Delayed graft function (DGF) rates were 51% versus 46% versus 29% (p < 0.0001), and 5-year patient and death-censored kidney graft survival rates were 96.8% versus 83.5% versus 82.2% (p = 0.002) and 86.7% versus 77.8% versus 78.8% (p = 0.18) in the high tSCr AKI versus lower tSCr AKI versus control groups, respectively.

CONCLUSIONS

Despite a higher incidence of DGF, patients receiving kidneys from DDs with tSCr levels ≥3.0 mg/dL have acceptable medium-term outcomes compared to either AKI DDs with a lower tSCr or DDs with a tSCr < 1.0 mg/dL.

摘要

介绍

本研究旨在回顾性分析我们中心根据终末期血清肌酐（tSCr）水平移植来自急性肾损伤（AKI）供体的肾脏的经验。

方法

AKI 肾脏的定义为供体入院时血清肌酐（SCr）升高两倍以上，且 tSCr≥2.0mg/dL。

结果

自 2007 年 1 月至 2021 年 11 月，我们共移植了 236 例 AKI 供体的肾脏，其中 100 例 tSCr≥3.0mg/dL（高 tSCr AKI 组，平均 tSCr 为 4.2mg/dL），其余 136 例来自 tSCr 为 2.0-2.99mg/dL 的供体（低 tSCr AKI 组，平均 tSCr 为 2.4mg/dL）。将这两组 AKI 与 996 例同期接受 tSCr<1.0mg/dL 的供体肾脏的患者进行比较。平均随访时间为 69 个月。延迟肾功能恢复（DGF）率分别为 51%、46%和 29%（p<0.0001），5 年患者和受死亡影响的移植物存活率分别为 96.8%、83.5%和 82.2%（p=0.002）和 86.7%、77.8%和 78.8%（p=0.18）。