Integrated strategy for preventing delayed renal graft function

A. Shabunin, O. Loran, D. Pushkar, E. Veliev, M. Minina, P. Drozdov, I. Nesterenko, D. A. Makeev, V. M. Sevostiyanov, O. S. Zhuravel, S. А. Astapovich, L. R. Karapetyan
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Abstract

Objective: to determine the efficacy and safety of an integrated strategy aimed at preventing delayed renal graft function (DGF).Materials and methods. From June 2018 to December 2022, 478 deceased-donor kidney transplants were performed at Botkin Hospital, Moscow. The patients were divided into two groups: Group I consisted of 128 patients who did not use the integrated strategy; Group II included 67 patients in whom the DGF prevention strategy was used at the perioperative stage. The integrated strategy involved the use of hypothermic oxygenated machine perfusion (HOPE) using expanded criteria donors, the use of a second warm ischemia (SWI) elimination device, personalized initial calcineurin inhibitor (CI) dosing, and use of alprostadil for high vascular resistance in renal graft arteries.Results. DGF occurred in 5 of 44 patients (11.4%) that used the integrated strategy, and in 13 of 44 patients (29.5%) in the control group. The differences were statistically significant (p = 0.034), there was a medium strength relationship between the traits (V = 0.225). The use of the integrated DGF prevention approach reduced the chances of developing DGF by a factor of 0.3 (95% CI: 0.1–0.95). The risk of DGF in the integrated strategy group was 61.3% of the risk of DGF in the non-strategy group, thus the relative risk (RR) is 1.63 (95% CI: 1.1–2.4). Median duration of graft function normalization was statistically significantly lower in group II: 5 (IQR: 3–9) versus 15 (IQR: 7–19) days (p = 0.012). Mean length of hospital stay was 19.1 ± 4.2 (95% CI: 14.5–26.1) bed-days in group I and 13.9 ± 3.4 (95% CI: 9.3–17.2) bed-days in group II. Differences in this indicator were also statistically significant (p = 0.043).Conclusion. The set of DGF prevention measures, developed at Botkin Hospital, evidence-based and implemented in clinical practice, can reduce the burden of modifiable risk factors of this complication significantly, thereby improving treatment outcomes for kidney transplant recipients considerably.
预防移植肾延迟功能的综合策略
目的:确定旨在预防延迟移植肾功能(DGF)的综合策略的有效性和安全性。材料和方法。从2018年6月到2022年12月,在莫斯科博特金医院进行了478例已故供者肾脏移植手术。患者被分为两组:第一组包括128名未使用综合策略的患者;II组包括67例围手术期采用DGF预防策略的患者。综合策略包括使用扩大标准供体的低温氧合机灌注(HOPE),使用第二次热缺血(SWI)消除装置,个性化初始钙调磷酸酶抑制剂(CI)剂量,以及使用前列地尔治疗肾移植动脉的高血管阻力。采用综合策略的44例患者中有5例(11.4%)发生DGF,对照组44例患者中有13例(29.5%)发生DGF。差异有统计学意义(p = 0.034),性状间呈中等强度相关(V = 0.225)。使用综合DGF预防方法可将发生DGF的机会降低0.3倍(95% CI: 0.1-0.95)。综合策略组DGF风险为非策略组DGF风险的61.3%,相对风险(RR)为1.63 (95% CI: 1.1-2.4)。II组移植物功能正常化的中位持续时间为5天(IQR: 3-9),而15天(IQR: 7-19),差异有统计学意义(p = 0.012)。平均住院时间I组为19.1±4.2 (95% CI: 14.5-26.1)床日,II组为13.9±3.4 (95% CI: 9.3-17.2)床日。该指标的差异也有统计学意义(p = 0.043)。Botkin医院开发的一套DGF预防措施,以证据为基础并在临床实践中实施,可以显著减轻该并发症可改变危险因素的负担,从而大大改善肾移植受者的治疗结果。
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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