Delayed Graft Function Phenotypes and 12-Month Kidney Transplant Outcomes.
Delayed Graft Function Phenotypes and 12-Month Kidney Transplant Outcomes.
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DOI：
10.1097/tp.0000000000001409
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发表时间：
2017-08
期刊：
影响因子：
6.2
通讯作者：
Parikh CR
中科院分区：
文献类型：
--
作者：
Hall IE;Reese PP;Doshi MD;Weng FL;Schröppel B;Asch WS;Ficek J;Thiessen-Philbrook H;Parikh CR
导致移植肾功能延迟的缺血-再灌注损伤(IRI)被器官共享联合网络定义为第一周透析(UNOS-DGF)，与不良的肾移植结果相关。然而，关于透析开始阈值以及用其他标准来表示不太严重的IRI或移植物功能缓慢(SGF)的有效性，仍然存在争议。对已故供者肾受者进行的多中心前瞻性研究，将UNOS-DGF与结合前48小时或透析过程中受损的肌酐减少的定义进行比较，以预测12个月的估计肾小球滤过率(EGFR)。我们还评估了10个基于肌酐和尿量的SGF定义相对于12个月的EGFR。在560名受者中，215名(38%)患有UNOS-DGF，330名(59%)符合综合定义，14名(3%)死亡，23名(4%)12个月后发生死亡审查的移植物失败。两种DGF定义都与调整后12个月的EGFR(95%CI)降低相关，分别为7.3(3.6-10.9)和7.4(3.8-11.0)ml/min/1.73m2。调整后的相对危险度分别为1.90(1.2-3.1)和2.1(1.1-3.7)，曲线下的未调整区域分别为0.618和0.627。对于SGF的定义，术后第7天的肌酐与12个月的EGFR有最强的相关性，在12个月的EGFR中，POD-2和POD-2之间的POD5肌酐和肌酐下降显示出适度的分离。虽然UNOS-DGF本身不能充分预测12个月的功能，但我们的发现不支持改变定义。POD7肌酐与12个月的EGFR相关，但需要进行大规模的翻译研究，以了解移植时IRI严重程度与长期结果之间的生物学联系。
Ischemia-reperfusion injury (IRI) leading to delayed graft function, defined by the United Network for Organ Sharing as dialysis in the first week (UNOS-DGF), associates with poor kidney transplant outcomes. Controversies remain, however, about dialysis initiation thresholds and the utility for other criteria to denote less severe IRI, or slow graft function (SGF). Multicenter, prospective study of deceased-donor kidney recipients to compare UNOS-DGF to a definition that combines impaired creatinine reduction in the first 48 hours or >1 dialysis session for predicting 12-month estimated glomerular filtration rate (eGFR). We also assessed 10 creatinine and urine output-based SGF definitions relative to 12-month eGFR. In 560 recipients, 215 (38%) had UNOS-DGF, 330 (59%) met the combined definition, 14 (3%) died and 23 (4%) had death-censored graft failure by 12 months. Both DGF definitions were associated with lower adjusted 12-month eGFR (95% CI)–by 7.3 (3.6–10.9) and 7.4 (3.8–11.0) ml/min/1.73m2, respectively. Adjusted relative risks for 12-month eGFR <30 ml/min/1.73m2 were 1.9 (1.2–3.1) and 2.1 (1.1–3.7), with unadjusted areas under the curve of 0.618 and 0.627, respectively. For SGF definitions, postoperative day (POD) 7 creatinine had the strongest association with12-month eGFR, and POD5 creatinine and creatinine reduction between POD1-2 demonstrated modest separations in 12-month eGFR. While UNOS-DGF does not adequately predict 12-month function on its own, our findings do not support changing the definition. POD7 creatinine is correlated with 12-month eGFR, but large translational studies are needed to understand the biological link between IRI severity at transplant and longer-term outcomes.