Angela L. Zhou, Suseela Raj, Ekaterina Fedorova, Jacqueline Garonzik-Wang, Didier Mandelbrot, Brad C. Astor, Sandesh Parajuli
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Older donor age, higher recipient body mass index, and receipt of a depleting induction agent were associated with increased risk for DGF in both DBD and DCD. In contrast, preemptive transplant and female recipient gender were associated with reduced risk. Additional risk factors in DBD, but not in DCD recipients, included higher donor terminal serum creatinine, higher kidney donor profile index, right donor kidney, and prolonged cold ischemia time. Female donors were associated with a reduced risk of DGF only among DCD donors. DGF was associated with higher AR and GF, with no significant differences across donor types, DBD vs. DCD (AR: adjusted hazard ratio [aHR] 2.22 vs. 2.37, p-interaction = 0.65; GF: 3.04 vs. 2.56; p-interaction = 0.47). DGF was associated with a higher risk for DWFG among DBD (aHR: 3.43, 95% CI: 1.96–6.00, <i>p</i> < 0.001) but not with DCD (aHR: 1.90, 95% CI: 0.78–4.61, <i>p</i> = 0.16), with p-interaction of 0.15</p>\n </section>\n \n <section>\n \n <h3> Conclusion</h3>\n \n <p>Despite higher DGF rates in DCD, early adverse outcomes after DGF were similar between deceased donor types and should not deter the utilization of DCD kidneys.</p>\n </section>\n </div>","PeriodicalId":10467,"journal":{"name":"Clinical Transplantation","volume":"39 6","pages":""},"PeriodicalIF":1.9000,"publicationDate":"2025-05-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/ctr.70199","citationCount":"0","resultStr":"{\"title\":\"Postkidney Transplant Delayed Graft Function Outcomes Are Not Worsened by Deceased Donor Type\",\"authors\":\"Angela L. 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引用次数: 0
摘要
与脑死亡（DBD）后捐赠相比，肾移植功能延迟（DGF）在循环死亡（DCD）后捐赠中更为常见。我们分析了2005年至2019年在我们中心死亡的肾移植受者（DDKTR），按供体类型（DBD vs. DCD）分层。方法：我们评估DGF、急性排斥反应（AR）、移植物衰竭（GF）以及移植物功能死亡（DWFG）的危险因素，以及不同供体类型对这些并发症的相互作用。结果2543例ddktr中，804例（32%）来自DCD供者。较大的供体年龄、较高的受体体重指数和接受消耗诱导剂与DBD和DCD患者DGF风险增加相关。相比之下，先发制人的移植和女性受体性别与风险降低有关。DBD的其他危险因素包括较高的供者终末血清肌酐、较高的肾脏供者特征指数、右侧供者肾脏和延长的冷缺血时间，但DCD受者没有。女性献血者仅在DCD献血者中与DGF风险降低有关。DGF与较高的AR和GF相关，不同供体类型间无显著差异，DBD与DCD (AR：校正风险比[aHR] 2.22 vs. 2.37， p-交互作用= 0.65；GF: 3.04 vs. 2.56；p-相互作用= 0.47)。DGF与DBD患者发生DWFG的高风险相关(aHR: 3.43, 95% CI: 1.96-6.00, p <；0.001)，但与DCD无关（aHR: 1.90, 95% CI: 0.78-4.61, p = 0.16）， p相互作用为0.15。结论尽管DCD患者DGF率较高，但DGF后的早期不良后果在已故供体类型之间相似，不应阻止DCD肾脏的使用。
Postkidney Transplant Delayed Graft Function Outcomes Are Not Worsened by Deceased Donor Type
Introduction
Kidney-delayed graft function (DGF) is more common in donation after circulatory death (DCD) donors in comparison to donatation after brain death (DBD). We analyzed deceased kidney transplant recipients (DDKTR) at our center between 2005 and 2019, stratified by donor type (DBD vs. DCD).
Methods
We assessed risk factors for DGF, acute rejection (AR), graft failure (GF), along with the death with functioning graft (DWFG), and the interaction between types of donors for those complications.
Results
Among 2543 DDKTRs, 804 (32%) were from DCD donors. Older donor age, higher recipient body mass index, and receipt of a depleting induction agent were associated with increased risk for DGF in both DBD and DCD. In contrast, preemptive transplant and female recipient gender were associated with reduced risk. Additional risk factors in DBD, but not in DCD recipients, included higher donor terminal serum creatinine, higher kidney donor profile index, right donor kidney, and prolonged cold ischemia time. Female donors were associated with a reduced risk of DGF only among DCD donors. DGF was associated with higher AR and GF, with no significant differences across donor types, DBD vs. DCD (AR: adjusted hazard ratio [aHR] 2.22 vs. 2.37, p-interaction = 0.65; GF: 3.04 vs. 2.56; p-interaction = 0.47). DGF was associated with a higher risk for DWFG among DBD (aHR: 3.43, 95% CI: 1.96–6.00, p < 0.001) but not with DCD (aHR: 1.90, 95% CI: 0.78–4.61, p = 0.16), with p-interaction of 0.15
Conclusion
Despite higher DGF rates in DCD, early adverse outcomes after DGF were similar between deceased donor types and should not deter the utilization of DCD kidneys.
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.
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