肾移植后早期移植肾功能异常的危险因素:146例非条件Logistic回归分析

Risk factors of early graft dysfunction following kidney transplantation: Unconditioned Logistic regression analysis of 146 cases

背景:肾移植后早期肾功能异常是多因素作用的结果,早期移植肾功能状态对移植肾长期存活有明显影响。目的:采用非条件Logistic回归方法分析早期移植肾功能异常的相关危险因素。设计、时间及地点:非条件Logistic回归分析,于2003-04/2006-09在解放军第三军医大学大坪医院野战外科研究所泌尿外科完成。对象:收集146例同种异体肾移植患者,根据肾移植后肾功能恢复情况,将患者分为早期肾功能正常组及早期肾功能异常组,后者包含移植肾功能延迟恢复组、移植肾功能缓慢恢复组。方法:回顾性分析146例次同种异体肾移植患者的临床资料,分析早期移植肾功能异常的相关因素及病因。主要观察指标:应用非条件Logistic回归方法分析早期移植肾功能异常的危险因素;观察移植肾功能异常患者急性肾小管坏死、急性排斥反应等并发症发生情况,并分析其危险因素。结果:①血管吻合时间、移植中发生低血压、男性受者、受者群体反应性抗体、HLA错配是早期移植肾功能异常的危险因素,其病因包括急性肾小管坏死、急性排斥反应、感染、外科并发症等。②血管吻合时间超过42min、术中发生低血压易发生急性肾小管坏死(P<0.01);HLA错配>3、群体反应性抗体≥10%、血管吻合时间超过42min易发生急性排斥反应(P<0.01)。结论:早期移植肾功能异常是包括免疫因素、非免疫因素在内的多种因素相互作用的结果,供受体的严格选择、控制移植中血压、完美的技术操作、早期病因诊断及针对性的治疗是防治的关键。

BACKGROUND： Early graft dysfunction following kidney transplantation results from many factors and exerts obvious influences on the long-term survival of renal grafts. OBJECTIVE： To investigate the risk factors of early graft dysfunction of kidney transplantation. DESIGN, TIME AND SETTING： The unconditioned Logistic analysis was carded out in the Department of Urinary Surgery, Institute of Battle Surgery, Daping Hospital, the Third Military Medical University of Chinese PLA （Chongqing, China） from April 2003 to September 2006. PARTICIPANTS： According to the early renal graft function, 146 patients undergoing allograft renal transplantation were divided into immediate graft function group and early graft dysfunction group, and the latter one comprised delayed recovery set and slow recovery set. METHODS： Clinical data of 146 renal transplantation recipients were analyzed retrospectively to determine the related risk factors and etiological diagnosis to the early graft dysfunction. MAIN OUTCOME MEASURES： Risk factors of early graft dysfunction were studied by unconditioned Logistic regression analysis; The complications, such as acute tubular necrosis and acute rejection, of the patients with early graft dysfunction and the risk factors were observed to analyze the risk factors. RESULTS： Vascular anastomosis time, hypotension during operation, male recipients, high panel reaction antibody and HLA mismatches were risk factors of early graft dysfunction. The etiological causes included acute tubular necrosis, acute rejection, infection and surgical complications, etc. Vascular anastomosis time exceeding 42 minutes and hypotension during operation trended to develop acute tubular necrosis （P 〈 0.01）; HLA mismatches 〉 3, panel reaction antibody ≥ 10% and vascular anastomosis time 〉 42 minutes trended to develop acute rejection AR （P 〈 0.01）. CONCLUSION： Multiple factors including immunologic factors, nonimmunologic factors and their interactions as well play an important role in early graft dysfunction. As to the prevention and cure, it is a key to select recipients strictly according to the tissue matching, control blood pressure during the surgery, operate perfectly, make an etiological diagnosis and treat directly as soon as possible.