The Detrimental Effect of Poor Early Graft Function After Laparoscopic Live Donor Nephrectomy on Graft Outcomes
The Detrimental Effect of Poor Early Graft Function After Laparoscopic Live Donor Nephrectomy on Graft Outcomes
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DOI：
10.1111/j.1600-6143.2008.02477.x
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发表时间：
2009-02-01
影响因子：
8.8
通讯作者：
Cooper, M.
中科院分区：
文献类型：
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作者：
Nogueira, J. M.;Haririan, A.;Cooper, M.
我们开展了这项研究，以评估腹腔镜活体供肾切除术后早期移植物功能不良(EGF)的发生率，并确定EGF不良是否与移植物长期存活率降低有关。研究人群包括我们中心946对连续的LapNx供受者对。不良EGF定义为术后第1天至第7天接受血液透析(移植肾功能延迟恢复[DGF])或术后第5天血肌酐<3.0 mg/dL而不需要血液透析(移植肾功能缓慢[SGF])。不良EGF的发生率为16.3%，其中DGF为5.8%，SGF为10.5%。不良的表皮生长因子与较差的死亡审查移植物存活率(校正风险比(HR)2.15，95%可信区间(CI)1.34-3.47，p=0.001)、移植物总体存活率(HR1.62，95%可信区间1.10-2.37，p=0.014)、较差的急性无排斥存活率(HR2.75，95%可信区间1.92-3.94，p<；0.001)和较差的一年肾功能(p=0.002)独立相关。即使SGF独立预测移植肾存活率较差(HR2.54，95%CI1.44-4.44，p=0.001)。DGF差的危险因素包括供者年龄较高、受者体重指数高、西罗莫司的使用和热缺血时间延长。综上所述，LapNx术后不良的EGF对移植物的长期功能和存活率有不良影响。
We undertook this study to assess the rate of poor early graft function (EGF) after laparoscopic live donor nephrectomy (lapNx) and to determine whether poor EGF is associated with diminished long-term graft survival. The study population consisted of 946 consecutive lapNx donors/recipient pairs at our center. Poor EGF was defined as receiving hemodialysis on postoperative day (POD) 1 through POD 7 (delayed graft function [DGF]) or serum creatinine >= 3.0 mg/dL at POD 5 without need for hemodialysis (slow graft function [SGF]). The incidence of poor EGF was 16.3% (DGF 5.8%, SGF 10.5%), and it was stable in chronologic tertiles. Poor EGF was independently associated with worse death-censored graft survival (adjusted hazard ratio (HR) 2.15, 95% confidence interval (CI) 1.34-3.47, p = 0.001), worse overall graft survival (HR 1.62, 95% CI 1.10-2.37, p = 0.014), worse acute rejection-free survival (HR 2.75, 95% CI 1.92-3.94, p < 0.001) and worse 1-year renal function (p = 0.002). Even SGF independently predicted worse renal allograft survival (HR 2.54, 95% CI 1.44-4.44, p = 0.001). Risk factors for poor DGF included advanced donor age, high recipient BMI, sirolimus use and prolonged warm ischemia time. In conclusion, poor EGF following lapNx has a deleterious effect on long-term graft function and survival.