供者尿液肾损伤标志物检测与肾移植预后的关系

Association between urine kidney injury biomarker of cardiac death donor and outcome of kidney recipient

目的:通过前瞻性研究心脏死亡器官捐献(DCD)供者脑死亡期间尿液肾损伤标志物与术后移植肾功能恢复延迟(DGF)及肾功能恢复的关系,阐明肾脏损伤标志物对移植肾预后的评估作用.方法:收集从2015年10月~2017年5月于天津市第一中心医院行DCD供肾肾移植术的101例患者资料,所有患者术后随访期为半年.结果:101例受者中出现DGF 9例(8.9%),平均术后6月肌酐为118.0±35.2μmol/L.单因素方差分析发现DGF影响因素包括供者肌酐(P=0.02)、尿中性粒细胞明胶酶相关脂质运载蛋白(NGAL)(P<0.001)、尿肾损伤分子1(KIM-1)(P<0.001)、尿白细胞介素18(IL-18)(P<0.001)、受者体质量指数(BMI)(P=0.024)及受者原发病(P=0.025).多因素回归分析发现,供者年龄和尿NGAL是DGF发生的独立危险因素.术后6个月肾功能的影响因素包括:供者BMI(P=0.01)、供者年龄(<0.001)、供者高血压(P=0.001)、尿KIM-1(P=0.008)、尿NGAL(P=0.001)、受者BMI(P=0.012)、受者性别(P=0.015).进行多因素线性回归分析后显示,供者尿NGAL、BMI和年龄是影响术后6个月肾功能的独立影响因素.结论:尿NGAL与DGF发生相关,且对于早期肾功能评估具有一定价值.

Objective:To assess the associations between urine kidney injury biomarker in donation after cardiac death(DCD) donor and outcome of kidney recipient. Methodology:We prospectively enrolled the data of 101 patients who underwent DCD donor kidney transplantation in our center from October 2015 to May 2017. We collected data of donor and recipient,and the postoperative follow-up period of all patients was half a year. Results:Among the 101 recipients,9 recipients(8.9%) had delayed graft function. The mean serum creatinine six month after surgery was 118.0±35.2 μmol/L. Univariate anova analysis showed that,the influence factors of delayed graft function(DGF) including serum creatinine(P=0.02),urinary neutrophil gelatinase-associated lipocalin(NGAL)(P<0.001),urinary kidney injury molecule-1(KIM-1)(P<0.001),urinary inteleukin-18(IL-18)(P<0.001) of the donor,body mass index(BMI)(P=0.024),and primary disease of the recipient(P=0.025). Multivariate regression analysis of the above factors showed that donor age(P=0.04) and urinary NGAL(P<0.001) were independent risk factors for DGF. Univariate anova analysis showed that renal function at 6 months after surgery was affected by BMI(P=0.01),age(<0.001),hypertension(P=0.001),urine kim-1(P=0.008) and urine NGAL(P=0.001) of the donor,BMI(P=0.012) and gender(P=0.015) of the recipient. Multivariate anova analysis of the above factors showed that independent factors affecting renal function at 6 month after surgery including: urinary NGAL(P=0.043),BMI(P=0.003),and age(P<0.001) of the donor. Conclusion:Urinary NGAL of DCD donor is associated with DGF of recipient,and it is valuable for the assessment of early renal function.