Delayed graft function is characterized by reduced functional mass measured by 99mtechnetium-mercaptoacetyltriglycine renography
Delayed graft function is characterized by reduced functional mass measured by 99mtechnetium-mercaptoacetyltriglycine renography
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DOI：
10.1097/00007890-200207270-00010
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发表时间：
2002-07-27
期刊：
影响因子：
6.2
通讯作者：
de Fijter, JW
中科院分区：
文献类型：
--
作者：
El-Maghraby, TAF;Boom, H;de Fijter, JW
背景移植物功能延迟恢复（DGF）的机制仍然不清楚。先前的研究使用肾小管功能测试表明，缺血后肾移植损伤导致严重损害的副免疫马尿酸（PAH）提取通过tubules. Methods。应用~（99 m）Tc-巯基乙酰三甘氨酸（~（99 m-MAG_3））肾显像和肾小管功能斜率（TFS），对移植肾即刻功能（IGF）和DGF受者进行了肾小管~（99 m-TcMAG_3）摄取的前瞻性研究。结果在移植后48小时内和移植后2周、3个月、6个月和3年内，对37例尸体移植肾和5例活体供肾的连续接受者进行了评价。除了方案扫描外，每隔一天对DGF受体进行检查，直到功能恢复。进行重复测量双向方差分析和变点分析，以确定两组之间TFS值随访的差异。14例患者被归类为DGF和28立即移植功能。在DGF组中，初始TFS值显著低于即刻移植物功能组（分别为0.54 [+/-0.01]和1.75 [+/-0.16]; P=0.002），差异持续长达3年。变化点分析显示，在前3 - 4周，两组的缺血后肾小管排泄随时间推移而改善，但两组在移植后3年仍存在差异。多因素分析显示，只有冷缺血时间是TFS值低的独立危险因素。在缺血后肾功能恢复初期，TFS可作为肾功能性肿块的一个指标。我们认为，根据Tc-99 m-MAG 3肾造影的定义，DGF中的肾小管缺陷是不可逆转的，并且可能是初始移植物功能的标志。
Background. The mechanism that underlies delayed graft function (DGF) is still poorly defined. Previous studies using tubular function tests have shown that postischemic injury to the renal transplants results in profound impairment of paraimmunohippurate (PAH) extraction through the tubules.Methods. Using (99m)Technetium-mercaptoacetyltriglycine (Tc-99m-MAG3) renography and tubular function slope (TFS), a study of the tubular uptake of (99m)TcMAG3 was undertaken in a prospective study of renal transplant recipients with immediate graft function (IGF) and those with DGF. Results. A total of 37 consecutive recipients of a cadaveric graft and 5 kidneys from living donors was evaluated within 48 hours after transplantation and in week 2, months 3 and 6, and 3 years after transplantation. In addition to the protocol scans, recipients with DGF were examined every other day until function was resumed. Repeated measurement two-way analysis of variance and a change point analysis were performed to determine the difference in the follow-up of TFS values between the two groups. Fourteen patients were classified as having DGF and 28 immediate graft function. In the DGF group, the initial TFS value was significantly lower than in the immediate graft function group (0.54 [+/-0.01] and 1.75 [+/-0.16], respectively; P=0.002), a difference that persisted for up to 3 years. Change point analysis revealed that the postischemic tubular excretion improved with time in both groups in the first 3 to 4 weeks, but both groups remained different up to 3 years after transplantation. Multivariate analysis revealed that only the cold ischemic time was an independent risk factor for a low TFS value. After the initial recovery from postischemic injury, the TFS may be used as a marker for functional renal mass.Conclusion. We propose that the tubular defect in DGF, as defined by Tc-99m-MAG3 renography, is irreversible and may be a marker of initial graft function.