器官移植2024，Vol.15Issue(4)：622-629,8.DOI:10.3969/j.issn.1674-7445.2024027
伴急性肾损伤的DBD供肾肾移植的临床结局
Clinical outcome of kidney transplantation from DBD donors complicated with acute kidney injury
摘要
Abstract
Objective To evaluate the clinical outcome of kidney transplantation from donation after brain death(DBD)donors complicated with acute kidney injury(AKI).Methods Clinical data of 216 DBD donors were retrospectively analyzed,and they were divided into the AKI group(n=69)and control group(n=147)according to the Kidney Disease:Improving Global Outcomes(KDIGO)guidelines.Donors in the AKI group were further divided into the KDIGO stage 1 and stage 2-3 subgroups.One hundred and thirty-five recipients were assigned into the AKI group and 288 recipients in the control group.Postoperative recovery of renal function and clinical outcomes of the recipients were recorded.The risk factors of delayed graft function(DGF)were identified.Results The highest serum creatinine(Scr)level,Scr level before procurement,the highest blood sodium level and blood sodium level before procurement in the AKI group were higher than those in the control group.The application duration of vasopressors in the AKI group was longer than that in the control group.In the AKI group,the amount of fluid resuscitation within 48 h was higher,the HCO3-level at admission was lower,and the incidence of diabetes insipidus and hypotension was higher than those in the control group.The highest Scr level and the Scr level before procurement in KDIGO stage 2-3 donors were significantly higher than those in KDIGO stage 1 counterparts(all P＜0.05).Compared with the control group,the incidence of DGF and acute rejection was higher,the proportion of continuous renal replacement therapy was higher,the Scr level within postoperative 90 d was higher,and the urine amount within postoperative 3 d was less than those of recipients in the AKI group.Compared with KDIGO stage 1 recipients,KDIGO stage 2-3 recipients had higher Scr levels at postoperative 3,4,5 and 15 d,and less urine amount at postoperative 2 d(all P＜0.05).Univariate analysis showed that donor age,the highest Scr level,the highest blood sodium level and the amount of fluid resuscitation within 48 h were the risk factors for DGF in recipients after kidney transplantation.Multivariate analysis showed that donor age was the independent risk factor for DGF in recipients after kidney transplantation(all P＜0.05).Conclusions For the application of DBD donors complicated with AKI,active organ maintenance should be performed to alleviate AKI.It exerts no effect upon graft function and survival rate at postoperative 6 months,which may achieve equivalent efficacy as non-AKI donors and may be used as a source of extended criteria donor kidneys.关键词
急性肾损伤/脑死亡/器官捐献/肾移植/边缘供者/器官维护/移植物功能延迟恢复/原发性无功能Key words
Acute kidney injury/Brain death/Organ donation/Kidney transplantation/Marginal donor/Organ maintenance/Delayed graft function/Primary nonfunction分类
医药卫生引用本文复制引用
王红宇,王亚方,李培亮,王红,沈松颖,赵贺,秦兴松,秦威,千新玲,董慧君,赵云峰..伴急性肾损伤的DBD供肾肾移植的临床结局[J].器官移植,2024,15(4):622-629,8.基金项目
河南省高等学校重点科研项目(23A320025) （23A320025）
