Machine Perfusion and Mitigating Risk Factors for Delayed Graft Function in Pediatric Kidney Transplant Recipients.

IF 1.4 4区医学 Q3 PEDIATRICS

Pediatric Transplantation Pub Date : 2026-08-01 DOI:10.1111/petr.70429

Kyle A Merrill, Cassie Kirby, Teresa Ambrosino, Charles D Varnell, Alexander Bondoc, Lakhmir Chawla, Stuart L Goldstein, David K Hooper

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引用次数: 0

Abstract

Background: Kidney transplantation confers prolonged and improved quality of life versus dialysis for patients with end-stage kidney disease (ESKD). Delayed graft function (DGF) increases the risk of allograft rejection and decreases allograft survival. In adults, prolonged warm (WIT) and cold ischemia time (CIT) increase risk of DGF, and machine perfusion (MP) during organ transportation reduces this risk. However, there is a paucity of data regarding risk factors for DGF in children.

Methods: We retrospectively evaluated risk and protective factors for DGF in patients aged 18 months to 21 years who underwent kidney transplantation at Cincinnati Children's Hospital Medical Center between 11/1/2017 and 11/30/2021. DGF was defined as receiving dialysis within 7 days post-transplant.

Results: Nine of 89 (10%) patients developed DGF. Patients with DGF had longer median WIT (49 IQR: 44-57 vs. 37 min IQR: 30-43; p = 0.002) and were more likely to have received a deceased donor (DD) allograft (p = 0.04, RR1.7 (95% CI: 1.2-2.4)). There was no difference in CIT between those who did and did not experience DGF (464 IQR:329-788 vs. 271 min. IQR:271-788; p = 0.16). No patients who received DD-MP kidneys developed DGF. DGF in recipients of DD-non-MP kidneys had longer WIT (53 IQR: 43-57 vs. 36 min. IQR: 30-44; p < 0.009).

Conclusion: Increased WIT increases the risk of DGF in pediatric kidney transplant recipients, whereas MP appears to be protective against DGF and may ameliorate the adverse effect of CIT. DGF was rare in the cohort and further studies are necessary due to the low incidence of DGF.

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机器灌注和减轻儿童肾移植受者移植功能延迟的危险因素。

背景：与透析相比，肾移植可以延长和改善终末期肾病（ESKD）患者的生活质量。移植功能延迟（DGF）增加了同种异体移植排斥反应的风险，降低了同种异体移植的存活率。在成人中，长时间的热缺血（WIT）和冷缺血（CIT）会增加DGF的风险，而器官运输过程中的机器灌注（MP）会降低这种风险。然而，缺乏关于儿童DGF危险因素的数据。方法：我们回顾性评估2017年11月1日至2021年11月30日在辛辛那提儿童医院医疗中心接受肾移植的18个月至21岁患者DGF的风险和保护因素。DGF定义为移植后7天内接受透析。结果：89例患者中有9例（10%）发生DGF。DGF患者的中位WIT更长（49 IQR: 44-57 vs. 37 IQR: 30-43; p = 0.002），并且更有可能接受已故供体（DD）同种异体移植（p = 0.04, RR1.7 (95% CI: 1.2-2.4)）。经历过和没有经历过DGF的患者的CIT没有差异（464 IQR:329-788 vs 271 min）。差:271 - 788;p = 0.16)。接受DD-MP肾脏治疗的患者没有发生DGF。dd -非mp肾受者DGF的WIT更长（53 IQR: 43-57 vs. 36 min）。差:30 - 44岁;结论：WIT升高会增加儿童肾移植受者发生DGF的风险，而MP似乎对DGF具有保护作用，并可能改善CIT的不良反应。该队列中DGF罕见，由于DGF的发生率较低，有必要进一步研究。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Pediatric Transplantation 医学-小儿科

CiteScore

2.90

自引率

15.40%

发文量

216

审稿时长

3-8 weeks

期刊介绍： The aim of Pediatric Transplantation is to publish original articles of the highest quality on clinical experience and basic research in transplantation of tissues and solid organs in infants, children and adolescents. The journal seeks to disseminate the latest information widely to all individuals involved in kidney, liver, heart, lung, intestine and stem cell (bone-marrow) transplantation. In addition, the journal publishes focused reviews on topics relevant to pediatric transplantation as well as timely editorial comment on controversial issues.