Delayed graft function is correlated with graft loss in recipients of expanded-criteria rather than standard-criteria donor kidneys: a retrospective, multicenter, observation cohort study
Delayed graft function is correlated with graft loss in recipients of expanded-criteria rather than standard-criteria donor kidneys: a retrospective, multicenter, observation cohort study
复制标题
移植物功能延迟与扩展标准而非标准标准供肾受者的移植物丢失相关：一项回顾性、多中心、观察队列研究
DOI：
10.1097/cm9.0000000000000666
复制
发表时间：
2020-03-05
影响因子：
6.1
通讯作者：
Sun, Qi-Quan
中科院分区：
文献类型：
--
作者：
Han, Fei;Lin, Min-Zhuan;Sun, Qi-Quan
摘要背景：虽然扩大标准供体（ECD）的使用缓解了器官短缺的问题，但它显着增加了移植物功能延迟（DGF）的发生率。 DGF是肾移植后常见的并发症；然而，根据已发表的文献，DGF 对移植物损失的影响尚不确定。因此，本研究的目的是确定 DGF 与同种异体移植物存活之间的关系。方法：我们进行了一项回顾性、多中心、观察队列研究。 2012年2月至2017年3月期间，共有284名已故捐赠者和541名受赠者被纳入其中。我们使用逻辑回归分析来验证临床参数与 DGF 之间的关联，并应用 Cox 比例风险模型来量化 DGF 导致肾移植丢失的风险比。结果：284 名已故捐献者中，65 名（22.8%）捐献者为 ECD。在 541 名受者中，107 名 (19.8%) 受者出现了 DGF，且 ECD 肾脏的发生率高于标准供体 (SCD) 肾脏的发生率 (29.2% vs. 17.1%；P = 0.003)。使用和不使用 DGF 的 SCD 肾受者之间的 5 年移植物存活率没有显着差异（95.8% 与 95.4%；P = 0.580）。然而，有和没有 DGF 的 ECD 肾受者之间存在显着差异（71.4% vs. 97.6%；P = 0.001），并且 DGF 受者移植物丢失的调整后风险比 (HR) 为 1.885（95% 置信区间 [CI] = 1.305–7.630；P = 0.024）。结果表明，抗胸腺细胞球蛋白诱导治疗对所有供肾均具有抗 DGF 保护作用（比值比 = 0.359；95% CI = 0.197–0.652；P = 0.001），并且是移植物存活的保护因素（HR = 0.308；95% CI = 0.130–0.728；P = 0.007），采用 ECD 肾脏。结论：DGF 是 ECD 肾脏受者移植物存活的独立危险因素，但不是 SCD 肾脏的受者。
Abstract Background: Although the use of expanded-criteria donors (ECDs) alleviates the problem of organ shortage, it significantly increases the incidence of delayed graft function (DGF). DGF is a common complication after kidney transplantation; however, the effect of DGF on graft loss is uncertain based on the published literature. Hence, the aim of this study was to determine the relationship between DGF and allograft survival. Methods: We conducted a retrospective, multicenter, observation cohort study. A total of 284 deceased donors and 541 recipients between February 2012 and March 2017 were included. We used logistic regression analysis to verify the association between clinical parameters and DGF, and Cox proportional hazards models were applied to quantify the hazard ratios of DGF for kidney graft loss. Results: Among the 284 deceased donors, 65 (22.8%) donors were ECD. Of the 541 recipients, 107 (19.8%) recipients developed DGF, and this rate was higher with ECD kidneys than with standard-criteria donor (SCD) kidneys (29.2% vs. 17.1%; P = 0.003). The 5-year graft survival rate was not significantly different between SCD kidney recipients with and without DGF (95.8% vs. 95.4%; P = 0.580). However, there was a significant difference between ECD kidney recipients with and without DGF (71.4% vs. 97.6%; P = 0.001), and the adjusted hazard ratio (HR) for graft loss for recipients with DGF was 1.885 (95% confidence interval [CI] = 1.305–7.630; P = 0.024). Results showed that induction therapy with anti-thymocyte globulin was protective against DGF (odds ratio = 0.359; 95% CI = 0.197–0.652; P = 0.001) with all donor kidneys and a protective factor for graft survival (HR = 0.308; 95% CI = 0.130–0.728; P = 0.007) with ECD kidneys. Conclusion: DGF is an independent risk factor for graft survival in recipients with ECD kidneys, but not SCD kidneys.