Poor early graft function impairs long-term outcome in living donor kidney transplantation.
Poor early graft function impairs long-term outcome in living donor kidney transplantation.
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DOI：
10.1007/s00345-012-0835-z
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发表时间：
2013-08
影响因子：
3.4
通讯作者：
Warle, M. C.
中科院分区：
文献类型：
--
作者：
Hellegering, J.;Visser, J.;Kloke, H. J.;D'Ancona, F. C. H.;Hoitsma, A. J.;van der Vliet, J. A.;Warle, M. C.
关键词：
活体肾移植（LDKT）后早期移植功能差（EGF）会降低无排斥移植的存活率。然而，其对移植物长期存活的影响尚无定论。收集了1996年7月至2010年2月期间进行的472例成人ldkt的数据。EGF不良被定义为发生延迟或缓慢的移植物功能。术后第5天无透析时血清肌酐高于3.0 mg/dL定义为功能缓慢。移植物功能缓慢和延迟的发生率分别为9.3和4.4%。受体超重、移植前透析和热缺血被认为是发生EGF不良的危险因素。EGF较差的无排斥生存期比立即移植物功能差，校正危险比（HR）为6.189 （95% CI 4.075-9.399; p < 0.001）。EGF差组的长期移植物存活受损，调整后风险比为4.206 （95% CI 1.839-9.621; p = 0.001）。13.7%的活体供体肾移植受者发生EGF不良。与具有即时移植物功能的患者相比，EGF较差的患者无排斥反应和长期移植物存活率均显著降低。这些结果强调了LDKT后EGF不良现象的临床相关性。
Poor early graft function (EGF) after living donor kidney transplantation (LDKT) has been found to decrease rejection-free graft survival rates. However, its influence on long-term graft survival remains inconclusive. Data were collected on 472 adult LDKTs performed between July 1996 and February 2010. Poor EGF was defined as the occurrence of delayed or slow graft function. Slow function was defined as serum creatinine above 3.0 mg/dL at postoperative day 5 without dialysis. The incidence of slow and delayed graft function was 9.3 and 4.4%, respectively. Recipient overweight, pretransplant dialysis and warm ischemia were identified as risk factors for the occurrence of poor EGF. The rejection-free survival was worse for poor EGF as compared to immediate graft function with an adjusted hazard ratio (HR) of 6.189 (95% CI 4.075–9.399; p < 0.001). Long-term graft survival was impaired in the poor EGF group with an adjusted HR of 4.206 (95% CI 1.839–9.621; p = 0.001). Poor EGF occurs in 13.7% of living donor kidney allograft recipients. Both, rejection-free and long-term graft survivals are significantly lower in patients with poor EGF as compared to patients with immediate graft function. These results underline the clinical relevance of poor EGF as phenomenon after LDKT.
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