Early graft function after living donor kidney transplantation predicts rejection but not outcomes
Early graft function after living donor kidney transplantation predicts rejection but not outcomes
复制标题
DOI：
10.1111/j.1600-6143.2004.00441.x
复制
发表时间：
2004-06-01
影响因子：
8.8
通讯作者：
Feng, S
中科院分区：
文献类型：
--
作者：
Brennan, TV;Freise, CE;Feng, S
死亡供体肾移植（DDKT）后早期移植肾功能（EGF）不良已被广泛研究。关于活体供肾移植（LDKT）后缺乏EGF的情况知之甚少。收集了1997年1月1日至2001年12月31日期间进行的469例LDKT的数据，以确定与EGF不良相关的风险因素和结局，定义为延迟或缓慢的移植功能（DGF或SGF）。DGF和SGF的发生率分别为4.7%和10.7%。糖尿病病因（OR 2.22; p=0.021）和热缺血时间（WIT）（OR 1.05/min增量; p=0.0025）与EGF缺乏独立相关。无论是功能性移植物存活率还是1年移植物功能在EGF组之间都没有差异。然而，DGF和SGF强烈倾向于急性排斥反应（AR），这损害了功能性移植物存活率（p=0.0007）和1年移植物功能。因此，我们得出结论，糖尿病肾病病因和WIT是LDKT后EGF不良的主要危险因素。差的EGF并不直接影响功能性移植物存活，但强烈倾向于AR。我们认为，免疫抑制应加强在贫困的EGF设置，以最大限度地延长LDKT寿命，因为AR不损害功能移植物存活。
Poor early graft function (EGF) after deceased donor kidney transplantation (DDKT) has been intensely studied. Much less is known about poor EGF after living donor kidney transplantation (LDKT). Data were collected on 469 LDKTs performed between 1/1/97 and 12/31/01 to determine risk factors for and outcomes associated with poor EGF, defined as either delayed or slow graft function (DGF or SGF). The incidence of DGF and SGF were 4.7% and 10.7%, respectively. Diabetic etiology (OR 2.22; p=0.021) and warm ischemia time (WIT) (OR 1.05 per min increment; p=0.0025) emerged as independently associated with poor EGF. Neither functional graft survival nor 1-year graft function differed among the EGF groups. However, DGF and SGF strongly predisposed to acute rejection (AR), which compromised functional graft survival (p=0.0007) and 1-year graft function. Therefore, we conclude that diabetic etiology of renal disease and WIT are the dominant risk factors for poor EGF after LDKT. Poor EGF did not directly compromise functional graft survival but strongly predisposed to AR. We suggest that immunosuppression should be intensified in the poor EGF setting to maximize LDKT longevity, as AR does impair functional graft survival.