移植肾功能延迟恢复对移植后贫血的影响

Influence of delayed graft function on post-transplant anemia

目的由于移植肾具有分泌促红细胞生成素的作用,可以改善尿毒症患者贫血的状况。边缘供体的使用让肾移植术后移植肾功能延迟恢复(delayed graft function,DGF)发生率越来越高,但目前仍无DGF过程是否影响移植后血红蛋白(hemoglobin,Hb)的相关研究。明确DGF过程对移植后Hb和贫血发生率的影响,将有利于诊疗方案的制订和预后评估。方法回顾性收集本中心94例肾移植的临床资料。入组标准为同一供者的一对肾脏分配给不同的受者,其中一个发生了DGF(DGF组),另一个未发生DGF(nDGF组)。分析两组在围术期和术后远期的Hb和变化情况及贫血的发生率。结果DGF组的受者在围术期Hb降低幅度较大(P<0.05),且在术后1个月时明显低于nDGF组(P=0.035)。在术后3、6、12个月,两组间Hb值无明显差异(P>0.05),且有一定相关性(PCCs=0.426,0.504,0.391)。移植术后1年,两组患者贫血的发生率无显著差异(P=0.959)。结论在供体质量相似的情况下,DGF的发生使受者在围术期Hb的降低幅度较大,但对术后远期(3~12个月)Hb无明显影响,对贫血的发生率也无显著影响。接受来自同一供者肾脏的两个受者,术后远期Hb值具有相关性。

Objective Kidney transplantation can improve anemia in uremia patients due to the secretion of erythropoietin by the transplanted kidney.The use of marginal donors leads to an increasing incidence of delayed graft function(DGF)after renal transplantation,but there is still no study on whether the DGF process has an impact on post-transplant hemoglobin of transplant recipients.Understanding the impact of the DGF process on hemoglobin(Hb)and the incidence of post-transplantation anemia is helpful for the development of medical protocols and prognosis assessment.Methods A single center study of 94 kidney transplants recipients were included,47 deceased donors were assigned as pairs of kidneys to two different recipients,one with DGF(in the DGF group)and one without DGF(in the nDGF group).Their perioperative and post-operative hemoglobin changes and incidence of anemia were analyzed.Results Patients in the DGF group had a greater perioperative decrease in hemoglobin(P<0.05),which was significantly lower than the nDGF group at one month post-operation(P=0.035).At 3,6,and 12 months post-transplantation,there was no significant differences in hemoglobin levels between the two groups(P<0.05),while there was a certain kind of correlation(PCCs=0.426,0.504,0.391).There was no significant difference in the incidence of anemia 1 year post-transplantation between the two groups(P=0.959).Conclusion With similar donor quality,DGF resulted in a significant decline of hemoglobin of the recipient at perioperative period,but had no significant effect on the long-term(3~12 month)hemoglobin level,and no significant effect on the incidence of anemia.Long-term hemoglobin of the two recipients from the same donor were associated with each other.