器官捐献肾移植受者近期预后的影响因素分析
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国家自然科学基金面上项目(81570676,81770751,81470981);国家自然科学基金青年基金项目(81100532);江苏省“333高层次人才培养工程”(BRA2015469,BRA2016514);江苏省“科教兴卫”工程医学重点人才培养资助项目(RC2011055);江苏省“六大人才高峰”资助项目(2010WSN?56,2011?WS?033);江苏省卫生厅面上项目(H2009907)


Risk factors on the short⁃term outcome of DCD kidney transplanted recipients:A single⁃center study
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    摘要:

    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,eGFR)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eGFR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eGFR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eGFR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。

    Abstract:

    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(eGFR)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,P<0.001),compared with recipients without DGF. On multivariate analysis of 1-year eGFR 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 eGFR of recipients. These factors should be considered while evaluating potential donors.

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阙宏亮,韩志坚,耿 亮,居小兵,陶 俊,陈 浩,孙 黎,谭若芸,顾 民.器官捐献肾移植受者近期预后的影响因素分析[J].南京医科大学学报(自然科学版),2018,(5):616-621,627

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  • 收稿日期:2018-01-04
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  • 在线发布日期: 2018-05-16
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