{"title":"肾机灌注与移植物长期存活的改善有关，这是由移植物延迟功能的减少介导的：一项配偶肾分析。","authors":"Gabriel Cojuc-Konigsberg, Bhavna Chopra","doi":"10.1111/aor.15066","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>Kidney machine perfusion (MP) prevents delayed graft function (DGF). Whether this benefit translates into improved long-term graft survival (LGS) remains uncertain. We evaluated the association between MP and LGS and its potential mediation by DGF.</p><p><strong>Methods: </strong>UNOS analysis of adult deceased donor kidney transplant recipients (KTRs) from January 2010 to June 2019. We selected KTRs with cold ischemia time (CIT) > 12 h and on tacrolimus maintenance. We included KTRs from dual-kidney donors and compared outcomes where one mate kidney received MP and the other did not. The primary endpoint was all-cause graft failure (GF) analyzed using a stratified multivariable Cox proportional hazards model. We assessed the association of MP and DGF with conditional logistic regression. We evaluated the mediation effect of DGF by combining the predictor and outcome models and bootstrapping with 1000 iterations to calculate 95% confidence intervals (CI).</p><p><strong>Results: </strong>We included 2355 mate-kidney pairs with 5.8 years (IQR 4-8) median follow-up. MP was associated with lower GF risk (aHR 0.86, 95% CI 0.75-0.98) and DGF odds (aOR 0.41, 95% CI 0.34-0.51) than no MP. DGF fully mediated the association between MP and GF, as the effect was no longer statistically significant after adjusting for DGF (aHR 0.89, 95% CI 0.78-1.03). DGF explained 76.8% of the association between MP and GF.</p><p><strong>Conclusions: </strong>In mate-kidney pairs with discordant MP use and CIT > 12 h, MP was associated with decreased GF risk, mediated by decreased DGF likelihood. MP both mate kidneys with CIT > 12 h should be considered to potentially improve LGS.</p>","PeriodicalId":8450,"journal":{"name":"Artificial organs","volume":" ","pages":""},"PeriodicalIF":2.3000,"publicationDate":"2025-08-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Kidney Machine Perfusion Is Associated With Improved Long-Term Graft Survival Mediated by Reduced Delayed Graft Function: A Mate-Kidney Analysis.\",\"authors\":\"Gabriel Cojuc-Konigsberg, Bhavna Chopra\",\"doi\":\"10.1111/aor.15066\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Background: </strong>Kidney machine perfusion (MP) prevents delayed graft function (DGF). Whether this benefit translates into improved long-term graft survival (LGS) remains uncertain. We evaluated the association between MP and LGS and its potential mediation by DGF.</p><p><strong>Methods: </strong>UNOS analysis of adult deceased donor kidney transplant recipients (KTRs) from January 2010 to June 2019. We selected KTRs with cold ischemia time (CIT) > 12 h and on tacrolimus maintenance. We included KTRs from dual-kidney donors and compared outcomes where one mate kidney received MP and the other did not. The primary endpoint was all-cause graft failure (GF) analyzed using a stratified multivariable Cox proportional hazards model. We assessed the association of MP and DGF with conditional logistic regression. We evaluated the mediation effect of DGF by combining the predictor and outcome models and bootstrapping with 1000 iterations to calculate 95% confidence intervals (CI).</p><p><strong>Results: </strong>We included 2355 mate-kidney pairs with 5.8 years (IQR 4-8) median follow-up. MP was associated with lower GF risk (aHR 0.86, 95% CI 0.75-0.98) and DGF odds (aOR 0.41, 95% CI 0.34-0.51) than no MP. DGF fully mediated the association between MP and GF, as the effect was no longer statistically significant after adjusting for DGF (aHR 0.89, 95% CI 0.78-1.03). DGF explained 76.8% of the association between MP and GF.</p><p><strong>Conclusions: </strong>In mate-kidney pairs with discordant MP use and CIT > 12 h, MP was associated with decreased GF risk, mediated by decreased DGF likelihood. MP both mate kidneys with CIT > 12 h should be considered to potentially improve LGS.</p>\",\"PeriodicalId\":8450,\"journal\":{\"name\":\"Artificial organs\",\"volume\":\" \",\"pages\":\"\"},\"PeriodicalIF\":2.3000,\"publicationDate\":\"2025-08-04\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Artificial organs\",\"FirstCategoryId\":\"5\",\"ListUrlMain\":\"https://doi.org/10.1111/aor.15066\",\"RegionNum\":3,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q3\",\"JCRName\":\"ENGINEERING, BIOMEDICAL\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Artificial organs","FirstCategoryId":"5","ListUrlMain":"https://doi.org/10.1111/aor.15066","RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q3","JCRName":"ENGINEERING, BIOMEDICAL","Score":null,"Total":0}
引用次数: 0
摘要
背景：肾机灌注（MP）可预防移植延迟功能（DGF）。这种益处是否转化为移植长期存活（LGS）的改善仍不确定。我们评估了MP和LGS之间的关系以及DGF对其潜在的中介作用。方法：UNOS分析2010年1月至2019年6月成人死亡供肾移植受者（KTRs）。我们选择冷缺血时间（CIT）为0 ~ 12 h且他克莫司维持的KTRs。我们纳入了双肾供者的ktr，并比较了一个配偶肾接受MP和另一个未接受MP的结果。主要终点是全因移植物衰竭（GF），使用分层多变量Cox比例风险模型进行分析。我们用条件逻辑回归评估了MP和DGF的关系。我们通过结合预测模型和结果模型以及1000次迭代的bootstrapping来计算95%置信区间（CI）来评估DGF的中介效应。结果：我们纳入了2355对配对肾脏，中位随访时间为5.8年（IQR 4-8）。与无MP患者相比，MP患者GF风险（aHR 0.86, 95% CI 0.75-0.98）和DGF风险（aOR 0.41, 95% CI 0.34-0.51）较低。DGF完全介导MP和GF之间的关联，因为在调整DGF后，该效应不再具有统计学意义（aHR 0.89, 95% CI 0.78-1.03）。DGF解释了76.8%的MP和GF之间的关联。结论：在不一致使用MP和CIT在12小时内的配对肾对中，MP与GF风险降低相关，这是由DGF可能性降低介导的。应考虑MP与CIT在12小时内配对肾脏可能改善LGS。
Kidney Machine Perfusion Is Associated With Improved Long-Term Graft Survival Mediated by Reduced Delayed Graft Function: A Mate-Kidney Analysis.
Background: Kidney machine perfusion (MP) prevents delayed graft function (DGF). Whether this benefit translates into improved long-term graft survival (LGS) remains uncertain. We evaluated the association between MP and LGS and its potential mediation by DGF.
Methods: UNOS analysis of adult deceased donor kidney transplant recipients (KTRs) from January 2010 to June 2019. We selected KTRs with cold ischemia time (CIT) > 12 h and on tacrolimus maintenance. We included KTRs from dual-kidney donors and compared outcomes where one mate kidney received MP and the other did not. The primary endpoint was all-cause graft failure (GF) analyzed using a stratified multivariable Cox proportional hazards model. We assessed the association of MP and DGF with conditional logistic regression. We evaluated the mediation effect of DGF by combining the predictor and outcome models and bootstrapping with 1000 iterations to calculate 95% confidence intervals (CI).
Results: We included 2355 mate-kidney pairs with 5.8 years (IQR 4-8) median follow-up. MP was associated with lower GF risk (aHR 0.86, 95% CI 0.75-0.98) and DGF odds (aOR 0.41, 95% CI 0.34-0.51) than no MP. DGF fully mediated the association between MP and GF, as the effect was no longer statistically significant after adjusting for DGF (aHR 0.89, 95% CI 0.78-1.03). DGF explained 76.8% of the association between MP and GF.
Conclusions: In mate-kidney pairs with discordant MP use and CIT > 12 h, MP was associated with decreased GF risk, mediated by decreased DGF likelihood. MP both mate kidneys with CIT > 12 h should be considered to potentially improve LGS.
期刊介绍：
Artificial Organs is the official peer reviewed journal of The International Federation for Artificial Organs (Members of the Federation are: The American Society for Artificial Internal Organs, The European Society for Artificial Organs, and The Japanese Society for Artificial Organs), The International Faculty for Artificial Organs, the International Society for Rotary Blood Pumps, The International Society for Pediatric Mechanical Cardiopulmonary Support, and the Vienna International Workshop on Functional Electrical Stimulation. Artificial Organs publishes original research articles dealing with developments in artificial organs applications and treatment modalities and their clinical applications worldwide. Membership in the Societies listed above is not a prerequisite for publication. Articles are published without charge to the author except for color figures and excess page charges as noted.
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