Early Graft Function After Laparoscopically Procured Living Donor Kidney Transplantation
Early Graft Function After Laparoscopically Procured Living Donor Kidney Transplantation
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DOI：
10.1016/j.juro.2010.06.013
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发表时间：
2010-10-01
影响因子：
6.6
通讯作者：
Reddy, Kunam
中科院分区：
文献类型：
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作者：
Tyson, Mark;Castle, Erik;Reddy, Kunam
目的：我们确定了腹腔镜活体供肾移植术后早期移植物功能不良的预测因素。材料和方法：我们对本机构的活体供肾移植数据库进行了机构审查委员会批准的审查。结果：510例移植肾中有7例(1%)因血管并发症立即行移植肾切除而被排除在研究之外。在剩余的503例移植物中，48例(9.5%)移植物功能缓慢，18例(3.6%)移植物功能延迟。在多因素Logistic回归模型中，受者男性(OR2.03，95%CI1.05~3.91，p=0.035)、黑人(OR1.59，95%CI1.08~2.34，p=0.020)和供者年龄(OR1.03，95%CI1.00~1.05，p=0.021)是早期移植物功能不良的独立预测因素。早期移植物功能不良可使患者在第1年发生急性排斥反应(HR3.43，95%CI2.04-5.77，p=0.0001)，而来自有遗传关系的供者的移植物具有保护作用(HR0.40，95%CI0.24-0.66，p=0.0001)。延迟功能组和缓慢功能组的3年死亡审查同种异体移植物存活率低于即时功能组(分别为89%和87%比98%，p=0.0068和0.0002)。延迟功能组的患者总体3年存活率低于即时功能组(81%比94%，p<；0.0001)。结论：男性黑人男性受者接受来自50岁以上供者的活体供体肾移植，早期移植肾功能不良的风险较高，而这反过来又强烈预测第一年的急性排斥反应。这一点很重要，因为良好的早期移植肾功能赋予了特定的受者和同种异体移植物存活优势，可能有助于医生更好地了解影响临床结果的不同受者、供者和围手术期参数。
Purpose: We determined predictors of poor early graft function after laparoscopic living donor kidney transplantation.Materials and Methods: We performed an institutional review board approved review of the living donor kidney transplantation database at our institution.Results: Seven of the 510 transplants (1%) were excluded from study due to immediate graft nephrectomy for vascular complications. Of the remaining 503 transplants 48 (9.5%) and 18 (3.6%) had slow and delayed graft function, respectively. Recipient male gender (OR 2.03, 95% CI 1.05-3.91, p = 0.035), black ethnicity (OR 1.59, 95% CI 1.08-2.34, p = 0.020) and donor age (OR 1.03, 95% CI 1.00-1.05, p = 0.021) emerged as independent predictors of poor early graft function in multivariate logistic regression models. Poor early graft function strongly redisposed patients to acute rejection during year 1 (HR 3.43, 95% CI 2.04-5.77, p = 0.0001) while grafts from genetically related donors conferred a protective effect (HR 0.40, 95% CI 0.24-0.66, p = 0.0001). Three-year death censored allograft survival was lower in the delayed and slow graft function groups than in the immediate function group (89% and 87% vs 98%, p = 0.0068 and 0.0002, respectively). Overall 3-year patient survival was lower in the delayed than in the immediate function group (81% vs 94%, p < 0.0001).Conclusions: Male black recipients of laparoscopically procured living donor kidney transplants from donors older than 50 years are at higher risk for poor early graft function, which in turn strongly predicts acute rejection during year 1. This is significant since excellent early graft function confers specific recipient and allograft survival advantages, and may assist physicians in better understanding the various recipient, donor and perioperative parameters that influence clinical outcomes.