器官捐献肾移植受者近期预后的影响因素分析

Risk factors on the short-term outcome of DCD kidney transplanted recipients:A singlecenter study

目的:探讨公民逝世后器官捐献(donation after citizen`s deceased,DCD)肾移植受者近期预后供受体影响因素。方法:回顾性分析2015年1月1日—2016年10月31日本中心来源于DCD供肾肾移植手术的供受体临床资料,探讨影响肾移植受者移植肾功能延迟恢复(delayed graft function,DGF)的发生率及术后1年肾小球滤过率(estimated-glomerular filtration rate,e GFR)情况的相关因素。结果:DCD供肾移植术后受者DGF发生率为28.2%。单因素分析结果显示,影响DGF发生的供受体危险因素有供体为女性(P=0.019)、体重指数(P=0.027)、热缺血时间(P=0.044)、有心肺复苏(cardio-pulmonary resuscitation,CPR)史(P=0.042)。而多因素分析结果也表明,供体年龄(P=0.027)及热缺血时间(P=0.042)为肾移植受者DGF发生的独立影响因素。此外,与未发生DGF的受者相比,发生DGF者其术后住院时间延长(P=0.020),住院费用增加(P=0.012),且术后1年内急性排异未发生率较低(P<0.001)。对于肾移植术后1年受者e GFR影响因素的多因素分析结果显示,供体年龄和受体术后1年内急性排异反应发生是术后1年受者e GFR水平的独立影响因素(P值分别为0.005和0.034)。结论:在DCD供肾移植中供体年龄和供肾热缺血时间是术后受者DGF发生的独立影响因素;而供体年龄及术后1年内急性排异反应发生是术后1年受者e GFR的独立影响因素。在评估潜在供体的各项指标时应将这类指标作为重点评估项目。

Objective：To discuss donors＇ and recipients＇ risk factors for the short-term outcomes of kidney transplanted recipients from donation after citizen＇s deceased（DCD）. Methods：We retrospectively analyzed the information of donors and recipients at the Kidney Transplantation Center,Jiangsu Province Hospital from January 1,2015 to Oct 31,2016. We compared the risk factors of delayed graft function（DGF）and 1-year estimated-glomerular filtration rate（e GFR）of recipients. Results：The DGF rate of kidney transplanted recipients from DCD was 28.2%. On univariate analysis of DGF,female in donor（P=0.019）,body mass index（BMI）of donor（P=0.027）,warm ischemia time（WIT,P=0.044）,and the history of cardio-pulmonary resuscitation（CPR,P=0.042）were showed significant differences. On multivariate analysis,age of donor（P=0.027）and WIT（P=0.042）were independent risk factors for the incidence of DGF. Recipients with DGF had more hospital stay（P=0.020）,more hospitalization expenses（P=0.012）and more incidence of acute rejection（AR,P0.001）,compared with recipients without DGF. On multivariate analysis of 1-year e GFR of recipients,age of donor（P=0.005）and the complications of AR（P=0.034）were independent risk predictors. Conclusion：Age of donor and WIT were independent risk factors for the incidence of DGF of recipients. Age of donor and the complications of AR were independent risk predictors for 1-year e GFR of recipients. These factors should be considered while evaluating potential donors.