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脑死亡后与心脏死亡后肾移植中早期移植物功能障碍的差异影响:来自荷兰国家移植登记处的见解

The differential impact of early graft dysfunction in kidney donation after brain death and after circulatory death: Insights from the Dutch National Transplant Registry.

作者信息

Steenvoorden Thei S, Evers Lara, Vogt Liffert, Rood Janneke A J, Kers Jesper, Baas Marije C, Christiaans Maarten H L, Lindeman Jan H N, Sanders Jan-Stephan F, de Vries Aiko P J, van Zuilen Arjan D, Bemelman Frederike J, Peters-Sengers Hessel

机构信息

Department of Internal Medicine, Section Nephrology, Amsterdam UMC, location AMC, Amsterdam Cardiovascular Sciences, University of Amsterdam, Amsterdam, The Netherlands.

Department of Internal Medicine, Section Nephrology, Amsterdam UMC, location AMC, Amsterdam Cardiovascular Sciences, University of Amsterdam, Amsterdam, The Netherlands.

出版信息

Am J Transplant. 2025 Mar;25(3):556-566. doi: 10.1016/j.ajt.2024.09.030. Epub 2024 Sep 27.

Abstract

Kidneys donated after circulatory death (DCD) perform similarly to kidneys donated after brain death (DBD). However, the respective incidences of delayed graft function (DGF) differ. This questions the donor type-specific impact of early graft function on long-term outcomes. Using competing risk and Cox-regression analysis, we compared death-censored graft loss between types of early graft function: DGF (temporary dialysis dependency started within 7 days after transplantation), slow graft function (3-day plasma creatinine decline less than 10% per day), and immediate graft function. In 1061 DBD and 1605 DCD graft recipients (January 2014 until January 2023), graft survival was similar. DGF was associated with death-censored graft loss in DBD and DCD (adjusted hazard ratios: DGF in DBD: 1.79 [1.04-2.91], P = .027, DGF in DCD: 1.84 [1.18-2.87], P = .008; Reference: no DGF). Slow graft function was associated with death-censored graft loss in DBD, but not significantly in DCD (adjusted hazard ratios DBD: 2.82 (1.34-5.93), P = .007, and DCD: 1.54 (0.72-3.35), P = .262; Reference: immediate graft function). Early graft dysfunction has a differential impact on graft outcome in DBD and DCD. The differences between DBD and DCD should be accounted for in research and the clinic.

摘要

循环死亡后捐赠的肾脏(DCD)与脑死亡后捐赠的肾脏(DBD)功能相似。然而,延迟移植肾功能(DGF)的发生率有所不同。这对早期移植肾功能对长期结果的供体类型特异性影响提出了质疑。我们使用竞争风险和Cox回归分析,比较了不同类型早期移植肾功能(DGF,移植后7天内开始临时透析依赖;缓慢移植肾功能,术后3天血浆肌酐每天下降少于10%;以及立即移植肾功能)之间经死亡校正的移植肾丢失情况。在1061例DBD和1605例DCD移植受者中(2014年1月至2023年1月),移植肾存活率相似。DGF与DBD和DCD中经死亡校正的移植肾丢失相关(校正风险比:DBD中的DGF为1.79 [1.04 - 2.91],P = 0.027;DCD中的DGF为1.84 [1.18 - 2.87],P = 0.008;参考:无DGF)。缓慢移植肾功能与DBD中经死亡校正的移植肾丢失相关,但在DCD中无显著相关性(校正风险比:DBD为2.82(1.34 - 5.93),P = 0.007;DCD为1.54(0.72 - 3.35),P = 0.262;参考:立即移植肾功能)。早期移植功能障碍对DBD和DCD的移植结果有不同影响。在研究和临床中应考虑DBD和DCD之间的差异。

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