探讨肝移植中边际供者与低肾功能受者匹配的可行性

IF 1.9 4区医学 Q2 SURGERY

Clinical Transplantation Pub Date : 2025-03-10 DOI:10.1111/ctr.70123

Miho Akabane, Yuki Imaoka, Toshihiro Nakayama, Carlos O. Esquivel, Kazunari Sasaki

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引用次数: 0

摘要

背景：终末期肝病（MELD）3.0评分相同的肝移植（LT）候选人的肾功能存在差异。边缘移植对肝移植后肾功能和预后的影响因肝移植前肾功能的不同而不同。我们探讨了将低肾功能受者与边缘供者配对对移植存活（GS）和肾移植后肾功能的影响。方法：我们分析了移植受者科学登记处（SRTR）的数据，通过估计肾小球滤过率（eGFR）将lt前肾功能分为低（<30 mL/min/1.73 m2）和高（≥30 mL/min/1.73 m2）。边际供者的定义标准包括心源性死亡、年龄≥65岁、严重大脂肪变性（≥30%）或体重指数≥40 kg/m2。主要结局是比较低和高肾前肾功能患者在肝移植后3年的GS。此外，我们检查了lt后1-3个月的eGFR。结果在13279例肝移植受体中，12851例肝移植前eGFR高，428例肝移植前eGFR低。Kaplan-Meier生存分析显示，与高eGFR受体相比，低lt前eGFR受体的3年GS显著降低(p <；0.01)。边缘供体器官的接受者也表现出3年GS的显著降低(p <；0.01)。这种不利影响在相同的MELD3.0类别中持续存在。此外，较低的肝移植前eGFR与肝移植后肾功能恶化的风险增加有关，特别是在接受边缘供者移植的患者中。多变量logistic回归识别接受者年龄>；65是lt后肾功能下降的重要危险因素(OR 3.34 [1.05-10.7]；P = 0.03)。在低lt前eGFR受体中，GS明显更差，特别是与边缘供者匹配时。接受者年龄>；65是边缘供者肝移植后肾功能恶化的风险指标，强调了谨慎的供受体匹配的重要性，尤其是肝移植前肾功能受损的人。

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Exploring the Viability of Matching Marginal Donors With Low Renal Function Recipients in Liver Transplantation

Background

Renal function varies among liver transplantation (LT) candidates with the same Model for End-Stage Liver Disease (MELD)3.0 score. The impact of marginal grafts on post-LT renal function and prognosis varies based on the pre-LT renal function. We explored the effects of matching recipients with low renal function to marginal donors on graft survival (GS) and post-LT kidney function.

Methods

We analyzed data from the Scientific Registry of Transplant Recipients (SRTR), categorizing pre-LT renal function by estimated glomerular filtration rate (eGFR) into low (<30 mL/min/1.73 m²) and high (≥30 mL/min/1.73 m²). Marginal donors were defined by criteria including donation after cardiac death, age ≥ 65, severe macrosteatosis (≥30%), or body mass index ≥ 40 kg/m². The primary outcome was to compare 3-year post-LT GS between patients with low and high pre-LT renal function. Additionally, we examined post-LT eGFR 1–3 months post-LT.

Results

Of 13 279 LT recipients, 12 851 had high pre-LT eGFR and 428 had low pre-LT eGFR. Kaplan–Meier survival analysis showed that recipients with low pre-LT eGFR had significantly lower 3-year GS compared to those with high eGFR (p < 0.01). Recipients of organs from marginal donors also exhibited a significant reduction in 3-year GS (p < 0.01). This adverse effect persisted within the same MELD3.0 category. Additionally, lower pre-LT eGFR was associated with an increased risk of post-LT kidney function deterioration, especially among those receiving grafts from marginal donors. Multivariable logistic regression identified recipient age > 65 as a significant risk factor for post-LT kidney function decline (OR 3.34 [1.05–10.7]; p = 0.03).

Discussion

GS was notably worse in recipients with low pre-LT eGFR, particularly when matched with marginal donors. A recipient age > 65 is a risk indicator for post-LT kidney function deterioration with marginal donors, underscoring the importance of careful donor-recipient matching, especially with compromised pre-LT kidney function.

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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.