建立尸体肾移植术后肾功能延迟恢复风险的供者评价系统的多中心研究

Multi-center study of establishing DGF risk assessment system for renal transplantation from deceased donor

目的探讨尸体供肾肾移植术后移植肾功能延迟恢复(delayed graft function, DGF)危险因素并建立供者评分系统。方法收集自2016年11月至2018年3月全国29家移植中心实施尸体供肾移植共3 549例受者及1 875例供者临床资料,单因素分析确定DGF的供者危险因素,将其纳入多因素分析,计算回归系数(β值)并换算成危险因素的评分,建立DGF风险供者评分系统。结果单因素分析显示,供者年龄,原发疾病,高血压病史,捐献前血肌酐水平,低血压时间和心肺复苏史是肾移植术后DGF的危险因素,在不同程度上均可增加DGF发生率。通过Logistic回归模型建立了基于以上6个危险因素的总分49分的DGF风险供者评分系统,随着供者评分由0分升高至49分,肾移植术后DGF发生率由9.96%增加至92%。结论本研究确定了尸体供肾肾移植术后DGF的供者危险因素,建立了一个符合中国人口特征的DGF风险供者预测评价系统,有助于临床医师用于尸体供者的评估,指导肾移植术后DGF的防治。

Objective To investigate the risk factors of delayed graft function(DGF)in organ donors after a citizen's death and establish a donor scoring system.Methods From November 2016 to March 2018,the clinical data of 1875 donors and 3549 recipients who performed renal transplantation from deceased donor in 29 transplant centers across the country were collected.Single factor analysis was used to determine the donor risk factors of DGF,and then incorporate multi-factor analysis,calculate the regression coefficient(βvalue)to establish a DGF risk donor score table.Results Univariate analysis showed that donor age,primary disease,history of hypertension,serum creatinine level before donation,hypotension and duration of CPR are risk factors for DGF after kidney transplantation,and DGF can be increased to varying degrees incidence rate.A logistic regression model was used to establish a DGF risk donor score table based on the above six risk factors with a total score of 49.As the donor score increased from 0 to 49,the incidence of DGF after renal transplantation increased from 9.96%to 92%.Conclusions The study has determined the risk factors of DGF donors after renal transplantation from decease donor,and established a scoring system for predicting DGF risk donors in line with the characteristics of the Chinese population,which is helpful for clinicians to evaluation of deceased donor and guiding treatment after renal transplantation.