Risk factors and outcomes of delayed graft function in renal transplant recipients receiving a steroid sparing immunosuppression protocol

AIM To analyse the risk factors and outcomes of delayed graft function(DGF) in patients receiving a steroid sparing protocol. METHODS Four hundred and twenty-seven recipients of deceased donor kidney transplants were studied of which 135(31.6%) experienced DGF. All patients received monoclonal antibody induction with a tacrolimus based, steroid sparing immunosuppression protocol.RESULTS Five year patient survival was 87.2% and 94.9% in the DGF and primary graft function(PGF) group respectively, P = 0.047. Allograft survival was 77.9% and 90.2% in the DGF and PGF group respectively, P < 0.001. Overall rejection free survival was no different between the DGF and PGF groups with a 1 and 5 year rejection free survival in the DGF group of 77.7% and 67.8% compared with 81.3% and 75.3% in the PGF group, P = 0.19. Patients with DGF who received IL2 receptor antibody induction were at significantly higher risk of rejection in the early post-transplant period than the group with DGF who received alemtuzumab induction. On multivariate analysis, risk factors for DGF were male recipients, recipients of black ethnicity, circulatory death donation, preformed DSA, increasing cold ischaemic time, older donor age and dialysis vintage.CONCLUSION Alemtuzumab induction may be of benefit in preventing early rejection episodes associated with DGF. Prospective trials are required to determine optimal immunotherapy protocols for patients at high risk of DGF.

Prediction of delayed graft function using different scoring algorithms: A single-center experience

AIM To compare the performance of 3 published delayed graftfunction(DGF) calculators that compute the theoretical risk of DGF for each patient.METHODS This single-center,retrospective study included 247 consecutive kidney transplants from a deceased donor.These kidney transplantations were performed at our institution between January 2003 and December 2012.We compared the occurrence of observed DGF in our cohort with the predicted DGF according to three different published calculators. The accuracy of the calculators was evaluated by means of the c-index(receiver operating characteristic curve).RESULTS DGF occurred in 15.3% of the transplants under study.The c index of the Irish calculator provided an area under the curve(AUC) of 0.69 indicating an acceptable level of prediction,in contrast to the poor performance of the Jeldres nomogram(AUC = 0.54) and the Chapal nomogram(AUC = 0.51). With the Irish algorithm the predicted DGF risk and the observed DGF probabilities were close. The mean calculated DGF risk was significantly different between DGF-positive and DGF-negative subjects(P < 0.0001). However,at the level of the individual patient the calculated risk of DGF overlapped very widely with ranges from 10% to 51% for recipients with DGF and from 4% to 56% for those without DGF.The sensitivity,specificity and positive predictive value of a calculated DGF risk ≥ 30% with the Irish nomogram were 32%,91% and 38%. CONCLUSION Predictive models for DGF after kidney transplantation are performant in the population in which they were derived,but less so in external validations.

Perioperative risk factors associated with delayed graft function following deceased donor kidney transplantation:A retrospective,single center study

BACKGROUND There is an abundant need to increase the availability of deceased donor kidney transplantation(DDKT)to address the high incidence of kidney failure.Challenges exist in the utilization of higher risk donor organs into what appears to be increasingly complex recipients;thus the identification of modifiable risk factors associated with poor outcomes is paramount.AIM To identify risk factors associated with delayed graft function(DGF).METHODS Consecutive adults undergoing DDKT between January 2016 and July 2017 were identified with a study population of 294 patients.The primary outcome was the occurrence of DGF.RESULTS The incidence of DGF was 27%.Under logistic regression,eight independent risk factors for DGF were identified including recipient body mass index≥30 kg/m^(2),baseline mean arterial pressure<110 mmHg,intraoperative phenylephrine administration,cold storage time≥16 h,donation after cardiac death,donor history of coronary artery disease,donor terminal creatinine≥1.9 mg/dL,and a hypothermic machine perfusion(HMP)pump resistance≥0.23 mmHg/mL/min.CONCLUSION We delineate the association between DGF and recipient characteristics of preinduction mean arterial pressure below 110 mmHg,metabolic syndrome,donorspecific risk factors,HMP pump parameters,and intraoperative use of phenylephrine.

Blessing and a curse of outpatient management of delayed graft function

Delayed graft function (DGF) is a common complication occurring most often after deceased donor kidney transplant with several donor characteristics as well as immunologic factors that lead to its development post-transplant.These patients require dialysis and close kidney function monitoring until sufficient allograft function is achieved.This has resulted in limited options for DGF management,either prolonged hospitalization until graft function improves to the point where dialysis is no longer needed or discharge back to their home dialysis unit with periodic follow up in the transplant clinic.DGF is associated with a higher risk for acute rejection,premature graft failure,and 30-d readmission;therefore,these patients need close monitoring,immunosuppression management,and prompt allograft biopsy if prolonged DGF is observed.This may not occur if these patients are discharged back to their home dialysis unit.To address this issue,the University of Wisconsin-Madison created a clinic in 2011 specialized in outpatient DGF management.This clinic was able to successfully reduce hospital length of stay without an increase in 30-d readmission,graft loss,and patient death.

Values of Donor Serum Lipids and Calcium in Predicting Graft Function after Kidney Transplantation:A Retrospective Study

Objective Delayed graft function(DGF)and early graft loss of renal grafts are determined by the quality of the kidneys from the deceased donor.As“non-traditional”risk factors,serum biomarkers of donors,such as lipids and electrolytes,have drawn increasing attention due to their effects on the postoperative outcomes of renal grafts.This study aimed to examine the value of these serum biomarkers for prediction of renal graft function.Methods The present study consecutively collected 306 patients who underwent their first single kidney transplantation(KT)from adult deceased donors in our center from January 1,2018 to December 31,2019.The correlation between postoperative outcomes[DGF and abnormal serum creatinine(SCr)after 6 and 12 months]and risk factors of donors,including gender,age,body mass index(BMI),past histories,serum lipid biomarkers[cholesterol,triglyceride,high-density lipoprotein(HDL)and low-density lipoprotein(DL)],and serum electrolytes(calcium and sodium)were analyzed and evaluated.Results(1)Donor age and pre-existing hypertension were significantly correlated with the incidence rate of DGF and high SCr level(≥2 mg/dL)at 6 and 12 months after KT(P<0.05);(2)The donor’s BMI was significantly correlated with the incidence rate of DGF after KT(P<0.05);(3)For serum lipids,merely the low level of serum HDL of the donor was correlated with the reduced incidence rate of high SCr level at 12 months after KT[P<0.05,OR(95%CI):0.425(0.202–0.97)];(4)The serum calcium of the donor was associated with the reduced incidence rate of high SCr level at 6 and 12 months after KT[P<0.05,OR(95%CI):0.184(0.045–0.747)and P<0.05,OR(95%CI):0.114(0.014–0.948),respectively].Conclusion The serum HDL and calcium of the donor may serve as predictive factors for the postoperative outcomes of renal grafts after KT,in addition to the donor’s age,BMI and pre-existing hypertension.

The Effect of Non-Invasive Goal Directed Fluid Administration on Graft Function in Deceased Donor Renal Transplantation: A Pilot Study

Background: Non-invasive goal directed fluid therapy during deceased donor renal transplant (CRT) may reduce the incidence of delayed graft function. Plethysmograph Variability Index (PVI) has been shown to predict fluid responsiveness during surgery. This pilot study evaluated the feasibility of goal directed fluid administration protocol based upon PVI studying the incidence of delayed graft function (DGF) in renal transplant recipients. Methods: Twenty patients underwent primary CRT. The Control group received intravenous fluid (IVF) at a calculated constant rate. The Treatment group received a baseline IVF infusion throughout the surgery. PVI values greater than 13% were treated with 250 ml boluses of IVF. Primary end point was DGF;total IVF administration and urinary biomarker NGAL levels were secondary endpoints. Results: Treatment group at every time point received significantly less IVF. There was no significant difference in incidence of DGF between the groups. 2 patients in the Control group and 6 in the Treatment group developed DGF. NGAL was not associated with the group assignment or total IVF given (p < 0.2). Conclusions: The effectiveness of goal directed fluid therapy with non-invasive dynamic parameters has not been validated in renal transplant surgery and larger prospective studies are needed to determine its utility in renal transplantation.

Predictive Score Model for Delayed Graft Function Based on Hypothermic Machine Perfusion Variables in Kidney Transplantation

Background: Hypothermic machine perfusion(HMP) is being used more often in cardiac death kidney transplantation; however, the significance of assessing organ quality and predicting delayed graft function(DGF) by HMP parameters is still controversial. Therefore,we used a readily available HMP variable to design a scoring model that can identify the highest risk of DGF and provide the guidance and advice for organ allocation and DCD kidney assessment.Methods: From September 1, 2012 to August 31, 2016, 366 qualified kidneys were randomly assigned to the development and validation cohorts in a 2:1 distribution. The HMP variables of the development cohort served as candidate univariate predictors for DGF. The independent predictors of DGF were identified by multivariate logistic regression analysis with a P < 0.05. According to the odds ratios(ORs) value, each HMP variable was assigned a weighted integer, and the sum of the integers indicated the total risk score for each kidney. The validation cohort was used to verify the accuracy and reliability of the scoring model.Results: HMP duration(OR = 1.165, 95% confidence interval [CI ]: 1.008–1.360, P = 0.043), resistance(OR = 2.190, 95%CI: 1.032–10.20, P < 0.001), and flow rate(OR = 0.931, 95% CI: 0.894–0.967, P = 0.011) were the independent predictors of identified DGF. The HMP predictive score ranged from 0 to 14, and there was a clear increase in the incidence of DGF, from the low predictive score group to the very high predictive score group. We formed four increasingly serious risk categories(scores 0–3, 4–7, 8–11, and 12–14)according to the frequency associated with the different risk scores of DGF. The HMP predictive score indicates good discriminative power with a c?statistic of 0.706 in the validation cohort, and it had significantly better prediction value for DGF compared to both terminal flow(P = 0.012) and resistance(P = 0.006).Conclusion: The HMP predictive score is a good noninvasive tool for assessing the quality of DCD kidneys, and it is potentially useful for physicians in making optimal decisions about the organs donated.

Delayed graft function is correlated with graft loss in recipients of expanded-criteria rather than standard-criteria donor kidneys:a retrospective,multicenter,observation cohort study

Background:Although the use of expanded-criteria donors(ECDs)alleviates the problem of organ shortage,it significantly increases the incidence of delayed graft function(DGF).DGF is a common complication after kidney transplantation;however,the effect of DGF on graft loss is uncertain based on the published literature.Hence,the aim of this study was to determine the relationship between DGF and allograft survival.Methods:We conducted a retrospective,multicenter,observation cohort study.A total of 284 deceased donors and 541 recipients between February 2012 and March 2017 were included.We used logistic regression analysis to verify the association between clinical parameters and DGF,and Cox proportional hazards models were applied to quantify the hazard ratios of DGF for kidney graft loss.Results:Among the 284 deceased donors,65(22.8%)donors were ECD.Of the 541 recipients,107(19.8%)recipients developed DGF,and this rate was higher with ECD kidneys than with standard-criteria donor(SCD)kidneys(29.2%vs.17.1%;P=0.003).The 5-year graft survival rate was not significantly different between SCD kidney recipients with and without DGF(95.8%vs.95.4%;P=0.580).However,there was a significant difference between ECD kidney recipients with and without DGF(71.4%vs.97.6%;P=0.001),and the adjusted hazard ratio(HR)for graft loss for recipients with DGF was 1.885(95%confidence interval[CI]=1.305–7.630;P=0.024).Results showed that induction therapy with anti-thymocyte globulin was protective against DGF(odds ratio=0.359;95%CI=0.197–0.652;P=0.001)with all donor kidneys and a protective factor for graft survival(HR=0.308;95%CI=0.130–0.728;P=0.007)with ECD kidneys.Conclusion:DGF is an independent risk factor for graft survival in recipients with ECD kidneys,but not SCD kidneys.

Predictive Score Model for Delayed Graft Function Based on Easily Available Variables before Kidney Donation after Cardiac Death

Background： How to evaluate the quality of donation after cardiac transplantation in China. Hence, the aim of this study was to develop kidneys before DCD. death （DCD） kidneys has become a critical problem in kidney a simple donor risk score model to evaluate the quality of DCD Methods： A total of 543 qualified kidneys were randomized in a 2：1 manner to create the development and validation cohorts. The donor variables in the development cohort were considered as candidate univariate predictors of delayed graft function （DGF）. Multivariate logistic regression was then used to identify independent predictors of DGF with P 〈 0.05. Date from validation cohort were used to validate the donor scoring model. Results： Based on the odds ratios, eight identified variables were assigned a weighted integer; the sum of the integer was the total risk score for each kidney. The donor risk score, ranging from 0 to 28, demonstrated good discriminative power with a C-statistic of 0.790. Similar results were obtained from validation cohort with C-statistic of 0.783. Based on the obtained frequencies of DGF in relation to different risk scores, we formed tour risk categories of increasing severity （scores 04, 5 9, 10-14, and 15 28）. Conclusions： The scoring model might be a good noninvasive tool for assessing the quality of DCD kidneys before donation and potentially useful for physicians to make optimal decisions about donor organ offers.

Risk factors for delayed graft function in cardiac death donor renal transplants

Background Delayed graft function （DGF） is common in kidney transplants from organ donation after cardiac death （DCD） donors. It is associated with various factors. Determination of center-specific risk factors may help to reduce the incidence of DGF and improve the transplantation results. The aim of this study is to define risk factors of DGF after renal transplantation.

氢吗啡酮术后镇痛对DCD肾移植患者术后早期DGF和排斥反应的影响

目的探讨氢吗啡酮术后镇痛对心脏死亡器官捐献(DCD)肾移植患者术后早期移植肾功能延迟恢复(DGF)和排斥反应的影响。方法回顾性分析解放军联勤保障部队第九二四医院自2021年1—12月行DCD肾移植术患者68例的资料,其中术后镇痛使用氢吗啡酮32例(A组)、非氢吗啡酮36例(B组)。通过回顾病例资料,统计术后不良反应发生率、血清胱抑素C(Cys-C)、C反应蛋白(CRP)、血清肌酐及其下降程度并进行比较。结果A组术后镇痛不良反应发生率、术后第3天CRP低于B组,差异有统计学意义(P<0.05);A组Cys-C术后第1天到术后第2天下降程度、血清肌酐术后第1天到术后第2天下降程度、CRP术后第2天到术后第3天下降程度高于B组,差异有统计学意义(P<0.05)。A组和B组的手术时间、出血量、术后同时段Cys-C、血清肌酐比较,差异无统计学意义(P>0.05)。结论氢吗啡酮用于DCD肾移植术后镇痛,能增加DCD肾移植患者术后早期Cys-C下降程度、肌酐下降程度,下调CRP,减少对移植肾的损伤,减少DGF发生的可能,预防排斥反应,更利于DCD移植肾功能的恢复。

公民逝世后器官捐献供者评估标准的研究

目的分析公民逝世后器官捐献供肾移植后肾功能延迟恢复（DGF）的危险因素,建立供者评估标准及评分系统。方法回顾性分析本中心2011年12月至2015年7月间367例公民逝世后器官捐献肾脏移植的临床资料。通过捐献者年龄、原发病、高血压病史、糖尿病病史、捐献前血肌酐水平、心肺复苏和低血压过程等与肾移植后DGF及肾功能恢复时间关系的单因素、多因素相关性分析及Cox回归分析,建立公民逝世后器官捐献供者的评估标准及评分系统。结果根据供者的年龄、原发病、高血压病史、捐献前血肌酐水平、心肺复苏和低血压程度等与肾移植后DGF相关的单因素及Cox回归分析结果,建立了供体评分系统,对367例肾移植受者的捐献者进行评分,供者评分〈5分的肾移植82例,DGF发生率5.4%,肾功能恢复时间4.2d;5~15分190例,DGF发生率6.7%,肾功能恢复时间5.1d;15~30分81例,DGF发生率33.9%,肾功能恢复时间8.2d;〉30分14例,DGF发生率50%,肾功能恢复时间27.3d。供者评分〉15分的供肾,DGF发生率显著高于评分低于15分的供肾（P〈0.05）,肾功能恢复时间延长;评分大于30分的供肾,肾功能恢复时间显著延长（P〈0.05）。结论供者的年龄、原发病、高血压病史、捐献前血肌酐水平、心肺复苏和低血压过程等与肾移植后DGF密切相关。根据DGF高危因素分析建立的供体评分系统及分级标准简单、实用、易行,对捐献者供肾质量可以做到客观的评估。适合我国公民逝世后器官捐献者供肾质量的评估。

应用LifePort器官转运器改善肾移植效果的大宗临床研究(附573例报告)

目的探讨供肾脉冲灌注保存转运器(LifePort)保存心脏死亡器官捐献(DCD)供肾和扩大标准供体(ECD)供肾对肾移植术后受者肾功能恢复的影响。方法回顾性分析466例器官捐献(DCD+ECD)供者和882例肾移植受者围手术期的临床资料。根据供肾保存方式不同,将309例DCD供者的左右两侧肾脏随机分为LifePort(DCD-LP)组(309例)和DCD冷藏组(309例);132例ECD供者的双侧供肾全部采用LifePort保存并转运,设为ECD-LP组(264例)。分别观察3组受者术后总体情况、术后早期移植肾功能指标、术后并发症发生情况;对比观察肾移植术前零点穿刺肾组织病理学检查结果;比较肾移植术后有否发生移植物功能延迟恢复(DGF)受者的供肾LifePort灌注参数。结果与DCD冷藏组比较,DCD-LP组、ECD-LP组受者的住院时间明显缩短,差异均有统计学意义(均为P<0.05)。DCD冷藏组、DCD-LP组、ECD-LP组围手术期的人存活率均为100%,肾存活率分别为99.7%、100%、99.2%,差异均无统计学意义(均为P>0.05)。与DCD冷藏组比较,DCD-LP组、ECD-LP组的DGF发生率明显降低,差异均有统计学意义(均为P<0.05)。3组受者的术后早期肾功能,急性排斥反应、感染和外科并发症的发生率比较,差异均无统计学意义(均为P>0.05)。病理学检查结果显示,采用LifePort灌注能明显减轻肾小管的水肿、变性、坏死。发生DGF者的供肾LifePort灌注阻力指数明显高于未发生DGF者,而供肾LifePort灌注流量则明显低于未发生DGF者,差异均有统计学意义(均为P<0.05)。结论 LifePort能有效改善离体DCD和ECD供肾质量,降低术后DGF发生率,促进移植肾功能恢复,并可在离体肾脏维护及评估中对术后恢复情况作出预判。

体外膜肺氧合对非可控型心脏死亡器官捐献供肾的保护作用

目的探讨体外膜肺氧合(ECMO)对非可控型心脏死亡器官捐献(DCD)供肾的保护效果。方法随机选取60例非可控型DCD患者,按ECMO体内灌注的时间将60例供体随机分为3组,实验组1利用ECMO灌注2 h,实验组2灌注4 h,实验组3灌注6 h,每组20例,相应受体亦分为3组,每组20例。同时随机选取20例接受循环功能稳定的脑死亡器官捐献(DBD)的受体作为对照组。比较各组受体的移植物功能延迟恢复(DGF)、原发性移植物无功能(PNF)和急性排斥反应的发生率;比较各组受体的移植肾恢复时间、术后第1日尿量和术后1年移植肾功能等指标;比较各组受体术后1年人、肾存活率。结果与对照组比较,各实验组受体的PNF、DGF及急性排斥反应发生率的差异均无统计学意义(均为P>0.05)。与对照组比较,各实验组的移植肾功能恢复时间明显延长,差异有统计学意义(均为P<0.05),而各实验组受体术后第1日尿量及术后1年的肾功能差异均无统计学意义(均为P>0.05)。各实验组及对照组肾移植术后1年的人、肾存活率均为100%,差异均无统计学意义(均为P>0.05)。结论利用ECMO技术辅助非可控型DCD的循环或呼吸功能可以很好地保护供肾功能,提高供肾使用率。

抑炎因子IL-35与移植肾功能延迟恢复关系的研究

目的探讨白细胞介素(IL)-35与移植肾功能恢复情况之间的关系。方法回顾性分析45例心脏死亡器官捐献(DCD)供肾肾移植受体的临床资料。根据肾移植术后是否发生移植物功能延迟恢复(DGF),所有受体分为早期肾功能恢复良好(IGF)组(32例)和DGF组(13例)。比较肾移植术后1、2、3、7、14、28 d及术后3个月、6个月、1年各时间点两组受体的血清肌酐(Scr)和估算肾小球滤过率(e GFR)水平;比较肾移植术后1、2、3、7、14、28 d各时间点两组受体血清和尿液IL-35含量。结果 DGF组受体术后肾功能恢复迟缓,术后7 d时Scr水平高于IGF组,e GFR水平低于IGF组,差异均有统计学意义(均为P<0.05)。术后1年,两组受体Scr水平的差异无统计学意义,但e GFR仍存在较大差异,与IGF组相比,DGF组受体术后1年时e GFR仍降低(P<0.05)。术后1、2、3、7、14 d,DGF组血清中IL-35含量均低于IGF组,两组比较差异均有统计学意义(均为P<0.05);术后28 d,与IGF组相比,DGF组血清IL-35含量反而升高,两组比较差异有统计学意义(P<0.05)。术后1、2、3、7 d,DGF组尿液中IL-35含量均低于IGF组,两组比较差异均有统计学意义(均为P<0.05);术后14、28 d,两组受体尿液IL-35含量进行比较,差异均无统计学意义(均为P>0.05)。结论肾移植术后受体血清和尿液中IL-35含量低与DGF发生存在一定的联系,提示术后早期受体全身和移植肾局部抑炎应答过弱,过度的炎症应答得不到有效控制,可能是DGF发生的重要原因。

肾移植术后受体脑卒中危险因素分析

目的分析肾移植受体发生脑卒中的危险因素。方法回顾性分析376例规律随访的肾移植受体的临床资料,按照是否发生脑卒中分为脑卒中组(39例)和非脑卒中组(337例)。采用单因素分析和COX比例风险回归模型分析脑卒中的危险因素。结果 376例受体的中位随访时间55个月,共有39例发生脑卒中,其累积发生率为10.4%。单因素分析发现,脑卒中组与非脑卒中组之间移植时年龄≥40岁、移植前透析时间≥12个月、估算肾小球滤过率(e GFR)<30 m L/(min·1.73 m2)、高血压、糖尿病、脂代谢异常的发生率比较,差异均有统计学意义(均为P<0.05)。多因素分析发现,影响肾移植受体脑卒中发生的独立危险因素为年龄≥40岁[风险比(HR)=1.110,95%可信区间(CI)为1.067~1.154,P=0.000]、移植前透析时间≥12个月(HR=1.044,95%CI为1.021~1.067,P=0.000)、e GFR<30 m L/(min·1.73 m2)(HR=2.448,95%CI为1.197~5.005,P=0.014)。结论肾移植受体发生脑卒中的独立危险因素包括年龄≥40岁、移植前透析时间长和肾功能减退。

肾移植术后高水平BK病毒尿症危险因素分析

目的分析肾移植术后高水平BK病毒尿症的危险因素及其对预防BK病毒相关性肾病(BKVAN)的意义。方法回顾性分析262例保留规律随访资料的肾移植受者的临床资料。根据受者BK病毒DNA载量分为高水平BK病毒尿症组(35例)和非高水平BK病毒尿症组(227例)。总结肾移植术后高水平BK病毒尿症的发生情况;采用单因素和多因素分析肾移植术后发生高水平BK病毒尿症的危险因素;采用Kaplan-Meier法绘制生存曲线,对受者进行生存分析。结果262例肾移植受者中,35例发生高水平BK病毒尿症,发生率为13.4%。发生中位时间181(126,315)d,发生率在移植术后6个月内最高,6个月至2年逐渐降低,2年后有所回升。单因素分析结果提示抗胸腺细胞球蛋白(ATG)治疗史、急性排斥反应(AR)、捐献类型及移植物功能延迟恢复(DGF)是肾移植术后发生高水平BK病毒尿症的危险因素(均为P<0.05)。多因素Cox回归分析结果显示脑-心双死亡器官捐献(DBCD)、AR及DGF是肾移植术后发生高水平BK病毒尿症的独立危险因素。有ATG治疗史、发生AR、发生DGF以及捐献类型为DBCD的受者的1、3、5年生存率分别低于无ATG治疗史、无发生AR、无发生DGF及其他捐献类型[脑死亡器官捐献(DBD)、心脏死亡器官捐献(DCD)和活体器官捐献]的受者(均为P<0.05)。结论DBCD、AR及DGF是肾移植术后发生高水平BK病毒尿症的独立危险因素,加强对此类受者的术后监测并给予早期干预可能是预防BKVAN的有效方式。

肾移植术后移植肾功能延迟恢复行连续性血液滤过的护理体会

目的:探讨移植肾功能延迟恢复(DGF)患者行连续性血液滤过的护理方法。方法:对12例DGF患者行连续性血液滤过治疗,严格无菌操作,加强心理护理及病情观察,合理使用抗凝药物,防止各种并发症。结果:移植肾功能延迟恢复的患者肾功能逐步恢复正常。

氧化应激反应在边缘供肝肝移植缺血-再灌注损伤中的作用研究进展

常见的边缘供肝主要包括脂肪变性供肝、高龄供肝、小体积供肝、心脏死亡器官捐献(DCD)供肝等。边缘供肝的应用可在一定程度上解决供肝数量严重短缺的问题,但边缘供肝面临着缺血-再灌注损伤(IRI)的难题,且IRI程度相比正常供肝更加严重,是导致移植失败的重要原因,其中氧化应激反应又是引起边缘供肝IRI的重要因素。因此如何减少氧化应激反应及解决边缘供肝IRI的难题成为临床研究的热点问题。活性氧簇(ROS)介导的氧化应激反应贯穿IRI整个过程,本文就氧化应激反应在边缘供肝肝移植IRI中的作用及以ROS为靶点的防治进行综述,以期为临床提供参考。

Update on ischemia-reperfusion injury in kidney transplantation: Pathogenesis and treatment

Ischemia/reperfusion injury is an unavoidable relevant consequence after kidney transplantation and influences short term as well as long-term graft outcome. Clinically ischemia/reperfusion injury is associated with delayed graft function, graft rejection, chronic rejection and chronic graft dysfunction. Ischemia/reperfusion affects many regulatory systems at the cellular level as well as in the renal tissue that result in a distinct inflammatory reaction of the kidney graft. Underlying factors of ischemia reperfusion include energy metabolism, cellular changes of the mitochondria and cellular membranes, initiation of different forms of cell death-like apoptosis and necrosis together with a recently discovered mixed form termed necroptosis. Chemokines and cytokines together with other factors promote the inflammatory response leading to activation of the innate immune system as well as the adaptive immune system. If the inflammatory reaction continues within the graft tissue, a progressive interstitial fibrosis develops that impacts long-term graft outcome. It is of particular importance in kidney transplantation to understand the underlying mechanisms and effects of ischemia/reperfusion on the graft as this knowledge also opens strategies to prevent or treat ischemia/reperfusion injury after transplantation in order to improve graft outcome.