Venkataraman Karthik, Irish Georgina L, Collins Michael G, Clayton Philip A
Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, SA, Australia.
Central and Northern Adelaide Renal and Transplantation Service, Royal Adelaide Hospital, Adelaide, SA, Australia.
Transpl Int. 2025 May 16;38:14197. doi: 10.3389/ti.2025.14197. eCollection 2025.
Delayed graft function (DGF), is associated with inferior graft outcomes. Whether poor graft function without dialysis, termed slow graft function (SGF), affects outcomes is unclear. We investigated associations between SGF (serum creatinine dropping by less than 30% between days 1 and 2), DGF and graft outcomes by donor type in a cohort of 17,579 Australian and New Zealand kidney transplant recipients from 2001-2021. The primary outcomes were graft survival and death-censored graft survival Compared with immediate graft function, both SGF (Adjusted hazard ratio [aHR] 1.48 (95% CI 1.14-1.91) and DGF [aHR 1.97 (1.42-2.73)] were associated with reduced graft survival in living donor and donation after brain death (DBD) recipients [SGF aHR 1.13 (1.01-1.27); DGF aHR 1.37 (1.24-1.51)]. In donation after circulatory death (DCD) recipients, DGF [(aHR 1.52 (1.13-2.04)] but not SGF [(aHR 1.55 (1.13-2.13)] was associated with reduced graft survival. Findings were similar for death-censored graft survival. In secondary analyses, SGFwas associated with reduced patient survival in living donor recipients. SGF and DGF were associated with lower 12-month eGFR for all donor types. DGF increased the odds of rejection for all donor types; for SGF this association was significant only for DBD recipients. SGF is associated with adverse outcomes in live donor and DBD kidney recipients.
移植肾功能延迟（DGF）与移植肾预后较差相关。无透析情况下的移植肾功能不佳，即所谓的移植肾功能缓慢（SGF），是否会影响预后尚不清楚。我们在2001年至2021年期间的17579名澳大利亚和新西兰肾移植受者队列中，按供体类型研究了SGF（第1天至第2天血清肌酐下降小于30%）、DGF与移植肾预后之间的关联。主要结局为移植肾存活和死亡删失的移植肾存活。与即刻移植肾功能相比，SGF（校正风险比[aHR]为1.48（95%置信区间1.14 - 1.91））和DGF（aHR为1.97（1.42 - 2.73））在活体供肾和脑死亡后供肾（DBD）受者中均与移植肾存活降低相关[SGF aHR为1.13（1.01 - 1.27）；DGF aHR为1.37（1.24 - 1.51）]。在循环死亡后供肾（DCD）受者中，DGF（aHR为1.52（1.13 - 2.04））与移植肾存活降低相关，但SGF（aHR为1.55（1.13 - 2.13））与移植肾存活降低无关。死亡删失的移植肾存活结果相似。在二次分析中，SGF与活体供肾受者的患者存活降低相关。SGF和DGF与所有供体类型的12个月估算肾小球滤过率（eGFR）降低相关。DGF增加了所有供体类型排斥反应的几率；对于SGF，这种关联仅在DBD受者中显著。SGF与活体供肾和DBD肾受者的不良结局相关。
