Nephron Underdosing as a Risk Factor for Impaired Early Kidney Graft Function and Increased Graft Loss During the Long-Term Follow-up Period
Nephron Underdosing as a Risk Factor for Impaired Early Kidney Graft Function and Increased Graft Loss During the Long-Term Follow-up Period
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DOI：
10.1016/j.transproceed.2012.12.019
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发表时间：
2013-05-01
影响因子：
0.9
通讯作者：
Wiecek, A.
中科院分区：
文献类型：
--
作者：
Kolonko, A.;Chudek, J.;Wiecek, A.
背景。人们普遍认为，从女性供体获得的肾脏在男性受体中可能表现不佳，主要是由于其体积较小和肾元剂量不足。目前，关于雌雄肾不相容对男性肾移植给女性受体的长期预后的不利影响，已经发表了相互矛盾的结果。本研究的目的是分析在一个相对同质的肾脏受体队列中，供受体性别匹配对移植早期功能和存活的影响。我们分析了477例生存时间超过3个月的已故供者的连续首次肾脏移植。高度敏感的受者和那些由于不遵医嘱而导致移植物损失的受者被排除在研究之外。早期肾移植功能的定义基于术后第3天血清肌酐（S-cr）浓度和透析需求：即刻移植因子（IGF; S-cr < 3mg/dL）、缓慢移植功能（S-cr bb0 3mg/dL且不透析）或延迟移植功能（DGF；移植后第一周透析）。IGF发生率最低的是接受女性肾移植的男性（F-M），为10.7%。女性供者IGF相对危险度为3.13(1.35 ~ 7.26)，男性供者相对危险度为3.13（1.35 ~ 7.26）。DGF的频率相似。在5年随访期间，54例移植物丢失。F-M组的损失风险明显更高：19.6% vs 8.8%，其他三个联合组(优势比= 2.54；95可信区间（1.41-4.59）；P = .002)。将女性肾脏移植给男性受体会损害早期肾脏移植功能，增加移植损失的风险。这种现象似乎与肾元剂量不足有关。
Background. It is generally accepted that kidneys procured from female donors may not perform optimally in male recipients, mostly due to their smaller size and nephron underdosing. Nowadays, conflicting results have been published regarding the detrimental effect of H-Y incompatibility on the long-term prognosis of male kidneys transplanted into female recipient. The aim of this study was an analysis of the impact of donor-recipient gender matching on early function and survival of grafts among a relatively homogenous cohort of kidney recipients.Methods. We analyzed 477 consecutive first kidney transplants from deceased donors with longer than 3-month survival. Highly sensitized recipients and those with graft losses attributed to noncompliance were excluded from the study. Early kidney graft function was defined based on serum creatinine (S-cr) concentrations at postoperative day 3 and the need for dialysis: immediate graft factors (IGF; S-cr < 3mg/dL), slow graft function (S-cr > 3mg/dL and no dialysis) or delayed graft function (DGF; dialysis in the first posttransplant week).Results. The lowest 10.7% incidence of IGF was observed among male recipients of female kidneys (F-M). For female donor, the relative risk for IGF in female recipient was 3.13 (1.35-7.26) than in male recipient. The frequencies of DGF were similar. During the 5-year follow-up, 54 grafts were lost. The risk for loss was significantly higher in the F-M group: 19.6% vs 8.8% in the three other combined groups (odds ratio = 2.54; 95 confidence interval (1.41-4.59); P = .002).Conclusions. Transplantation of the female kidney to a male recipient impairs early kidney graft function increasing the risk of graft loss over a 5-year follow-up. This phenomenon seems to be related to nephron underdosing.