Donation after cardiac death liver transplantation is associated with increased risk of end-stage renal disease.
Donation after cardiac death liver transplantation is associated with increased risk of end-stage renal disease.
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心脏死亡后的肝移植捐赠与终末期肾病的风险增加有关。
DOI：
10.1111/tri.12409
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发表时间：
2014
期刊：
影响因子：
--
通讯作者：
Abt,PeterL
中科院分区：
文献类型：
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作者：
Ruebner,RebeccaL;Reese,PeterP;Abt,PeterL
有限的器官供应导致更多地使用具有较高供体风险指数（DRI）和/或心源性死亡（DCD）后捐赠的肝脏移植物。DCD状态与肝移植后急性肾损伤相关;然而，关于供体质量与终末期肾病（ESRD）之间的关系知之甚少。使用SRTR数据，我们收集了2002年2月至2010年12月的肝移植受者队列。我们拟合了ESRD的多变量考克斯回归模型。模型1包括总DRI;模型2包括DRI的组成部分，包括DCD，作为单独的变量。共纳入4463例肝移植受者。中位DRI为1.40（IQR 1.14，1.72）; 1822例（5%）接受DCD肝脏。在中位随访3.93年期间，ESRD发生于2008年（5%），11075例（27%）受试者死亡。DRI越高，ESRD的危险性越高（DRI ≥1.14且<1.40：HR 1.17，P = 0.06; DRI ≥1.40且<1.72：HR 1.29，P = 0.003; DRI ≥1.72：HR 1.39，P < 0.001，与DRI <1.14相比）。单独调整DRI成分，DCD状态与ESRD最强相关（HR 1.40，P = 0.008）。较高的DRI与肝移植后的ESRD相关，部分原因是DCD状态。供体质量是肝移植受者长期肾脏结局的重要预测因素。
Limited organ supply has led to greater use of liver allografts with higher donor risk indices (DRI) and/or donated after cardiac death (DCD). DCD status is associated with acute kidney injury after liver transplantation; however, less is known about the association between donor quality and end‐stage renal disease (ESRD). Using SRTR data, we assembled a cohort of liver transplant recipients from 2/2002 to 12/2010. We fit multivariable Cox regression models for ESRD. Model 1 included total DRI; model 2 included components of DRI, including DCD, as separate variables. Forty thousand four hundred and sixty‐three liver transplant recipients were included. Median DRI was 1.40 (IQR 1.14, 1.72); 1822 (5%) received DCD livers. During median follow‐up of 3.93 years, ESRD occurred in 2008 (5%) and death in 11 075 (27%) subjects. There was a stepwise increase in ESRD risk with higher DRI (DRI ≥1.14 and <1.40: HR 1.17,P= 0.06; DRI ≥1.40 and <1.72: HR 1.29,P= 0.003; DRI ≥1.72: HR 1.39,P< 0.001, compared with DRI <1.14). Adjusting for DRI components separately, DCD status was most strongly associated with ESRD (HR 1.40,P= 0.008). Higher DRI is associated with ESRD after liver transplantation, driven in part by DCD status. Donor quality is an important predictor of long‐term renal outcomes in liver transplant recipients.