Effect of donor kidney volume on recipient outcome: does the "dose" matter?
Effect of donor kidney volume on recipient outcome: does the "dose" matter?
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供肾体积对受者结果的影响：“剂量”重要吗？
DOI：
10.1097/tp.0b013e31826f135e
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发表时间：
2012
期刊：
影响因子：
6.2
通讯作者：
Shihab,FuadS
中科院分区：
文献类型：
--
作者：
Sikora,MagdalenaB;Shaaban,Akram;Beddhu,Srinivasan;Bourija,Hassan;Wei,Guo;Baird,Bradley;Truax,CrystalM;Shihab,FuadS
BackgroundThe供体肾体积对受体肾功能的影响尚未得到充分evaluated.MethodsWe进行了前瞻性分析125连续活体肾供体/受体对。供体肾的体积通过移植前的计算机断层扫描血管造影片计算，采用三维计算机体积法。根据动脉期计算皮质体积，根据延迟期计算总体积。由于体重是代谢需求的替代指标，我们通过计算供体肾脏体积与受体体重的比值来研究“体积剂量”。通过使用慢性肾脏病流行病学协作组公式计算估计的肾小球滤过率（eGFR）来评估肾小球肾功能。Logistic回归模型用于评估12个月时eGFR < 60 mL/min/1.73 m2（eGFR< 60）的几率。结果由于皮质和总体积相关（R= 0.734，P< 0.001），我们使用总肾体积来评估剂量效应。平均捐献体积剂量（SD）为2.13（0.62）mL/kg。12个月时平均受体eGFR为63.6（17.3）mL/min/1.73m2，与体积剂量相关（r= 0.341，P< 0.001）。与最低三分位数相比，在多变量logistic回归模型中，供体肾体积与受体体重的最高三分位数中的患者发生eGFR <60 mL/min/1.73 m2的比值比较低（比值比为0.23; 95%置信区间为0.07-0.81）。样条回归表明，体积剂量大于2.5 mL/kg与最低风险的eGFR小于60 mL/min每1.73 m 2在12 monthsConclusionsDonor肾体积剂量是一个重要的决定因素，受体移植的结果，并可能预测受体肾功能在肾移植。
BackgroundThe effect of donor kidney volume on recipient kidney function has not been fully evaluated.MethodsWe performed a prospective analysis of 125 consecutive living kidney donor/recipient pairs. Donor kidney volume was calculated from pretransplantation computed tomography angiograms using a three-dimensional computerized volume method. Cortical volume was calculated from arterial phase and total volume from delayed phase. Because weight is a surrogate marker for metabolic demands, we looked at the “volume dose” by calculating the ratio of donor kidney volume to recipient weight. Recipient kidney function was assessed by calculating the estimated glomerular filtration rate (eGFR) using the Chronic Kidney Disease Epidemiology Collaboration formula. Logistic regression models were used to evaluate odds of developing eGFR of< 60 mL/min per 1.73 m 2 (eGFR< 60) at 12 months.ResultsBecause cortical and total volumes were correlated (R= 0.734, P< 0.001), we used total kidney volume to evaluate the dose effect. The mean donated volume dose (SD) was 2.13 (0.62) mL/kg. The mean recipient eGFR at 12 months was 63.6 (17.3) mL/min per 1.73 m 2, and it correlated with volume dose (r= 0.341, P< 0.001). Compared with the lowest tertile, those in the highest tertile of donor kidney volume to recipient weight had lower odds ratio of developing eGFR of less than 60 mL/min per 1.73 m 2 (odds ratio, 0.23; 95% confidence interval, 0.07–0.81) in a multivariate logistic regression model. Spline regression suggested that a volume dose greater than 2.5 mL/kg was associated with lowest risk of eGFR of less than 60 mL/min per 1.73 m 2 at 12 months.ConclusionsDonor kidney volume dosing is an important determinant of recipient graft outcomes and may predict recipient kidney function in kidney transplantation.