Cojuc-Konigsberg Gabriel, Chopra Bhavna
Division of Nephrology, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA.
Artif Organs. 2025 Aug 4. doi: 10.1111/aor.15066.
Kidney machine perfusion (MP) prevents delayed graft function (DGF). Whether this benefit translates into improved long-term graft survival (LGS) remains uncertain. We evaluated the association between MP and LGS and its potential mediation by DGF.
UNOS analysis of adult deceased donor kidney transplant recipients (KTRs) from January 2010 to June 2019. We selected KTRs with cold ischemia time (CIT) > 12 h and on tacrolimus maintenance. We included KTRs from dual-kidney donors and compared outcomes where one mate kidney received MP and the other did not. The primary endpoint was all-cause graft failure (GF) analyzed using a stratified multivariable Cox proportional hazards model. We assessed the association of MP and DGF with conditional logistic regression. We evaluated the mediation effect of DGF by combining the predictor and outcome models and bootstrapping with 1000 iterations to calculate 95% confidence intervals (CI).
We included 2355 mate-kidney pairs with 5.8 years (IQR 4-8) median follow-up. MP was associated with lower GF risk (aHR 0.86, 95% CI 0.75-0.98) and DGF odds (aOR 0.41, 95% CI 0.34-0.51) than no MP. DGF fully mediated the association between MP and GF, as the effect was no longer statistically significant after adjusting for DGF (aHR 0.89, 95% CI 0.78-1.03). DGF explained 76.8% of the association between MP and GF.
In mate-kidney pairs with discordant MP use and CIT > 12 h, MP was associated with decreased GF risk, mediated by decreased DGF likelihood. MP both mate kidneys with CIT > 12 h should be considered to potentially improve LGS.
肾脏机器灌注（MP）可预防移植肾功能延迟恢复（DGF）。这种益处是否能转化为改善长期移植肾存活（LGS）仍不确定。我们评估了MP与LGS之间的关联及其通过DGF的潜在中介作用。
对2010年1月至2019年6月成年已故供体肾移植受者（KTR）进行器官共享联合网络（UNOS）分析。我们选择冷缺血时间（CIT）>12小时且接受他克莫司维持治疗的KTR。我们纳入了来自双肾供体的KTR，并比较了一对肾中一个接受MP而另一个未接受MP的结局。主要终点是使用分层多变量Cox比例风险模型分析的全因移植肾失功（GF）。我们通过条件逻辑回归评估MP与DGF的关联。我们通过合并预测模型和结局模型并进行1000次迭代的自助法来评估DGF的中介效应，以计算95%置信区间（CI）。
我们纳入了2355对肾对，中位随访时间为5.8年（四分位间距4 - 8年）。与未进行MP相比，MP与较低的GF风险（调整后风险比[aHR]0.86，95%CI 0.75 - 0.98）和DGF几率（调整后优势比[aOR]0.41，95%CI 0.34 - 0.51）相关。DGF完全介导了MP与GF之间的关联，因为在调整DGF后效应不再具有统计学意义（aHR 0.89，95%CI 0.78 - 1.03）。DGF解释了MP与GF之间76.8%的关联。
在MP使用不一致且CIT>12小时的肾对中，MP与降低的GF风险相关，这是由降低的DGF可能性介导的。对于CIT>12小时的双肾对，应考虑对两个肾都进行MP，以潜在地改善LGS。
