供体急性肾损伤的严重程度会影响肾移植后的预后吗？

IF 1.9 4区医学 Q2 SURGERY

Clinical Transplantation Pub Date : 2024-08-08 DOI:10.1111/ctr.15425

Alexandra R. Monetti, Christopher J. Webb, Colleen L. Jay, Emily McCracken, Berjesh Sharda, Matthew Garner, Alan C. Farney, Giuseppe Orlando, Amber Reeves-Daniel, Alejandra Mena-Gutierrez, Natalia Sakhovskaya, Robert J. Stratta

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引用次数: 0

摘要

简介：研究目的是根据终末血清肌酐（tSCr）水平回顾性回顾我们单中心移植急性肾损伤（AKI）已故供体（DD）肾脏的经验：AKI肾脏的定义是DD入院SCr增加一倍且tSCr≥2.0 mg/dL：从2007年1月1日到2011年11月21日，我们移植了236个AKI DD肾脏，其中100个tSCr≥3.0 mg/dL（高SCr AKI组，平均tSCr为4.2 mg/dL），其余136个来自tSCr为2.0-2.99 mg/dL的DD（低SCr AKI组，平均tSCr为2.4 mg/dL）。这两组 AKI 患者与同时接受 DD 肾脏且 tSCr < 1.0 mg/dL 的 996 名对照组患者进行了比较。平均随访时间为 69 个月。在高tSCr AKI组与低tSCr AKI组和对照组中，移植功能延迟（DGF）率分别为51%对46%对29%（p < 0.0001），5年患者和死亡剪除肾脏移植存活率分别为96.8%对83.5%对82.2%（p = 0.002）和86.7%对77.8%对78.8%（p = 0.18）：结论：尽管DGF的发生率较高，但与tSCr水平≥3.0 mg/dL的AKI DD或tSCr<1.0 mg/dL的DD相比，接受tSCr水平≥3.0 mg/dL的DD肾脏的患者的中期预后是可以接受的。

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Does Severity of Donor Acute Kidney Injury Influence Outcomes Following Kidney Transplantation?

Introduction

The study purpose was to review retrospectively our single-center experience transplanting kidneys from deceased donors (DD) with acute kidney injury (AKI) according to terminal serum creatinine (tSCr) level.

Methods

AKI kidneys were defined by a doubling of the DD's admission SCr and a tSCr ≥ 2.0 mg/dL.

Results

From 1/07 to 11/21, we transplanted 236 AKI DD kidneys, including 100 with a tSCr ≥ 3.0 mg/dL (high SCr AKI group, mean tSCr 4.2 mg/dL), and the remaining 136 from DDs with a tSCr of 2.0–2.99 mg/dL (lower SCr AKI group, mean tSCr 2.4 mg/dL). These two AKI groups were compared to 996 concurrent control patients receiving DD kidneys with a tSCr < 1.0 mg/dL. Mean follow-up was 69 months. Delayed graft function (DGF) rates were 51% versus 46% versus 29% (p < 0.0001), and 5-year patient and death-censored kidney graft survival rates were 96.8% versus 83.5% versus 82.2% (p = 0.002) and 86.7% versus 77.8% versus 78.8% (p = 0.18) in the high tSCr AKI versus lower tSCr AKI versus control groups, respectively.

Conclusions

Despite a higher incidence of DGF, patients receiving kidneys from DDs with tSCr levels ≥3.0 mg/dL have acceptable medium-term outcomes compared to either AKI DDs with a lower tSCr or DDs with a tSCr < 1.0 mg/dL.

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来源期刊

Clinical Transplantation 医学-外科

CiteScore

3.70

自引率

4.80%

发文量

286

审稿时长

2 months

期刊介绍： Clinical Transplantation: The Journal of Clinical and Translational Research aims to serve as a channel of rapid communication for all those involved in the care of patients who require, or have had, organ or tissue transplants, including: kidney, intestine, liver, pancreas, islets, heart, heart valves, lung, bone marrow, cornea, skin, bone, and cartilage, viable or stored. Published monthly, Clinical Transplantation’s scope is focused on the complete spectrum of present transplant therapies, as well as also those that are experimental or may become possible in future. Topics include: Immunology and immunosuppression; Patient preparation; Social, ethical, and psychological issues; Complications, short- and long-term results; Artificial organs; Donation and preservation of organ and tissue; Translational studies; Advances in tissue typing; Updates on transplant pathology;. Clinical and translational studies are particularly welcome, as well as focused reviews. Full-length papers and short communications are invited. Clinical reviews are encouraged, as well as seminal papers in basic science which might lead to immediate clinical application. Prominence is regularly given to the results of cooperative surveys conducted by the organ and tissue transplant registries. Clinical Transplantation: The Journal of Clinical and Translational Research is essential reading for clinicians and researchers in the diverse field of transplantation: surgeons; clinical immunologists; cryobiologists; hematologists; gastroenterologists; hepatologists; pulmonologists; nephrologists; cardiologists; and endocrinologists. It will also be of interest to sociologists, psychologists, research workers, and to all health professionals whose combined efforts will improve the prognosis of transplant recipients.