血清β2-微球蛋白预测肾移植受者延迟肾功能恢复的时间。

Serum β2-Microglobulin Predicts Time to Recovery of Delayed Graft Function in Kidney Transplant Recipients.

机构信息

Division of Nephrology, Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA.

Department of Population Health Sciences, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA.

出版信息

Clin Transplant. 2024 Aug;38(8):e15435. doi: 10.1111/ctr.15435.

DOI:10.1111/ctr.15435

PMID:39158946

Abstract

BACKGROUND

Delayed graft function (DGF) after kidney transplantation is associated with adverse patients and allograft outcomes. A longer duration of DGF is predictive of worse graft outcomes compared to a shorter duration. Posttransplant serum β2-microglobulin (B2M) is associated with long-term graft outcomes, but its relationship with DGF recovery is unknown.

METHODS

We included all kidney-only transplant recipients with DGF enrolled in the E-DGF trial. Duration of DGF was defined as the interval between the transplant and the last dialysis session. We analyzed the association of standardized serum creatinine (Scr) and B2M on postoperative Days (POD) 1-7 during the subsequent days of DGF with the recovery of DGF.

RESULTS

A total of 97 recipients with DGF were included. The mean duration of DGF was 11.0 ± 11.2 days. Higher Scr was not associated with the duration of DGF in unadjusted or adjusted models. Higher standardized B2M, in contrast, was associated with a prolonged duration of DGF. This association remained in models adjusting for baseline characteristics from POD 2 (3.19 days longer, 95% CI: 0.46-5.93; p = 0.02) through Day 6 of DGF (4.97 days longer, 95% CI: 0.75-9.20; p = 0.02). There was minimal change in mean Scr (0.01 ± 0. 10 mg/dL per day; p = 0.32), while B2M significantly decreased as the time to recovery approached (-0.14 ± 0.05 mg/L per day; p = 0.006), among recipients with DGF.

CONCLUSION

B2M is more strongly associated with DGF recovery than Scr. Posttransplant B2M may be an important biomarker to monitor during DGF.

TRIAL REGISTRATION

ClinicalTrials.gov identifier: NCT03864926.

摘要

背景

肾移植后延迟肾功能（DGF）与患者和移植物不良结局相关。与较短时间相比，较长时间的 DGF 预示着更差的移植结局。移植后血清β2-微球蛋白（B2M）与长期移植物结局相关，但与 DGF 恢复的关系尚不清楚。

方法

我们纳入了 E-DGF 试验中所有发生 DGF 的单纯肾移植受者。DGF 的持续时间定义为移植与最后一次透析之间的时间间隔。我们分析了 DGF 期间术后第 1-7 天（POD）标准化血清肌酐（Scr）和 B2M 与 DGF 恢复的关系。

结果

共纳入 97 例 DGF 受者，DGF 的平均持续时间为 11.0±11.2 天。未校正和校正模型中，较高的 Scr 与 DGF 的持续时间无关。相比之下，较高的标准化 B2M 与 DGF 持续时间延长相关。该相关性在调整 POD2 时的基线特征的模型中仍然存在（DGF 期间延长 3.19 天，95%CI：0.46-5.93；p=0.02），直至 DGF 的第 6 天（延长 4.97 天，95%CI：0.75-9.20；p=0.02）。Scr 的平均值变化不大（每天增加 0.01±0.10mg/dL；p=0.32），而 B2M 在恢复时间接近时明显下降（每天减少 0.14±0.05mg/L；p=0.006）。