肾移植患者发生移植肾功能延迟恢复的危险因素分析及预测

目的 研究肾移植患者发生移植肾功能延迟恢复（BGF）的相关危险因素及预测方法。方法 回顾性分析212例具有完整人类白细胞抗原（HLA）配型资料的尸体肾移植患者的临床资料，对患者的性别、年龄、血型、乙型肝炎病毒感染情况、心功能分级、是否再次移植、透析时间长短、HLA配型情况、供肾热缺血时间、供肾冷缺血时间以及血管开放后泌尿时间进行严格的记录和评估。用一元logistic回归方法初步找出与DGF发生相关的因素，再用多元逐步logistic回归方法找出导致DGF发生的各项高危险因素，建立移植肾功能延迟恢复的logistic回归模型。结果 本组患者DGF发生率为16．51％。由一元logistic回归方法分析发现在α=0．05的水准上，DGF与心功能分级、透析时间、HLA-Ⅰ类错配、HLA总错配及移植肾冷缺血时间有关，但与是否再次移植、性别、年龄、血型、乙型肝炎病毒感染情况、肾脏热缺血时间、血管开放后泌尿时间等均无明显的相关性。用多元逐步logistic回归分析方法发现患者心功能分级、HLA-Ⅰ类抗原错配和移植肾冷缺血时间是影响DGF的重要因素。结论 DGF的发生不是移植肾冷保存时间过长或其它任何单一因素导致的，而是由供肾质量、免疫学因素和受者功能状况等多种因素决定的。应用DGF的多元回归预测模型，可以计算出患者发生DGF的概率，从而进行必要的临床干预，预防DGF的发生。     

肾移植术后早期消化道出血的危险因素分析及治疗

目的 研究肾移植患者术后早期发生消化道出血的危险因素及治疗方法.方法 回顾性分析266例次肾移植术后1个月内消化道出血患者的临床资料,用单因素logistic回归分析发病的相关因素,并用多元逐步logistic回归方法分析导致肾移植术后消化道出血的高危因素.总结消化道出血的治疗方法.结果 本组术后消化道出血发生率为10.5%,多发生于肾功能延迟恢复（DGF）期间,甲泼尼松总量、肺部感染、肝素透析及直接血管穿刺是肾移植术后发生消化道出血的高危因素.出血组患者移植肾脏近期存活率显著低于未出血组患者.及时、持续的抑制胃酸分泌有利于消化道出血的治疗.结论 DGF是发生消化道出血的高危时期,导致发病的危险因素多,及时、彻底地控制出血,适当调整免疫抑制剂的用量,积极预防肺部感染,合理应用透析方法有助于患者安全.应用多元逐步logistic回归分析,有助于判断消化道出血发生风险,并进行针对性的临床干预.     

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

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。     

肾移植术后早期移植肾失功的危险因素分析

目的探讨肾移植术后发生早期移植肾失功的危险因素。方法回顾性分析35例肾移植术后2个月内发生移植肾失功患者（失功组）和同期70例未发生移植肾失功患者（对照组）的临床资料,应用单因素分析和多因素逐步Logistic回归分析找出导致早期移植肾失功的危险因素和独立危险因素,得出回归方程,并计算该模型判断有危险因素病例的早期移植肾失功的准确率。结果单因素分析表明,两组间供肾的热缺血时间、冷缺血时间、供肾血管异常、受者术前群体反应性抗体（panel reactive antibody,PRA）水平、供受者之间人类白细胞抗原（human leucocyte antigen,HLA）位点错配数是影响肾移植术后早期移植肾失功的危险因素（P〈0.05-0.01）。多因素逐步Logistic回归结果提示供受者之间HLA位点错配数、受者术前PRA水平、供肾冷缺血时间是早期移植肾失功的独立危险因素,其优势比分别为7.823、5.389和1.259（P〈0.05-0.01）。由此得出回归方程为：Y=-8.544＋2.057X1＋1.684X2＋0.230X3,该模型对具有危险因素的病例发生早期移植肾失功的预测准确率为80%。结论供受者之间HLA位点错配数、受者术前PRA水平、供肾冷缺血时间是肾移植术后早期移植肾失功的高危因素。     

髂内动脉钙化对肾移植受者移植物功能延迟恢复和近期预后的影响

目的 分析髂内动脉钙化与肾移植受者移植物功能延迟恢复（DGF）及近期预后的相关性。方法 回顾性分析222例肾移植受者的临床资料。依据肾功能恢复情况分为DGF组（50例）和移植物功能正常恢复（IGF）组（172例）,根据是否合并髂内动脉重度钙化将DGF组和IGF组分为DGF高危组（22例）、DGF低危组（28例）、IGF高危组（41例）以及IGF低危组（131例）。比较两组供受者临床资料,总结肾移植术后DGF及髂内动脉钙化发生情况,分析肾移植术后发生DGF的危险因素、髂内动脉钙化与临床指标的相关性以及DGF合并髂内动脉重度钙化受者近期预后。结果 本研究中DGF发生率为22.5%(50/222)。肾移植受者中28.4%(63/222)合并髂内动脉重度钙化,DGF组中44%(22/50)合并髂内动脉重度钙化,高于IGF组中的23.8%(41/172)(P<0.05)。单因素分析结果显示供者终末血清肌酐（Scr）高、男性供者,受者甘油三酯水平高和髂内动脉重度钙化是肾移植术后发生DGF的危险因素（均为P<0.05）。多因素logistic回归分析显示供者Scr≥143μmol/L及受...     

肾移植术后高水平BK病毒尿症与HLA位点关联分析

目的探讨肾移植术后高水平BK病毒(BKV)尿症的时间分布, 以及高水平BKV尿症与临床因素以及供、受者特定人类白细胞抗原(HLA)位点的关联。方法回顾性分析于2017年1月1日至2019年12月31日于西安交通大学第一附属医院行器官捐献供肾肾移植的212例受者的资料, 定义肾移植术后尿液BKV-DNA定量大于107(拷贝/ml)尿液为高水平BKV尿症, 选择同期性别组成相同的低于该阈值的212例受者作为低水平对照组。对于两组间临床资料及HLA位点进行统计描述, 使用单因素以及多因素Logistic回归筛选高水平BKV尿症的危险因素。结果肾移植术后受者首次高水平BKV尿症发生时间中位数为125.5 d。在单因素Logistic分析中, 移植肾功能延迟(DGF)以及受者HLA-A24是高水平BKV尿症的危险因素, 供者HLA-DQ9是保护因素。在多因素Logistic分析中, DGF(OR=2.18, 95%CI 1.18～4.01, P=0.012)以及受者HLA-A24(OR=1.63, 95%CI 1.06～2.53, P=0.027)是高水平BKV尿症的独立危险因素, 供者HLA-...     

器官捐献肾移植功能延迟恢复的预后因素分析

目的探讨中国公民逝世后器官捐献(Chinese donation after citizens’death,CDCD)发生肾移植功能延迟恢复(delayed graft function,DGF)的预后因素。方法回顾性分析2014年1月~2015年11月在武汉大学中南医院138例行同种异体肾移植手术的临床资料,21例发生DGF(DGF组),117例移植肾功能稳定(immediate graft function,IGF)为IFG组,采用χ~2检验进行单因素分析,再用logistic模型对有统计学差异的因素进行多因素分析。结果 DGF发生率为15.2%(21/138),单因素分析显示DGF的预后因素包括受者术前血透时间≥12个月(P=0.024)、脑出血死亡供者(P=0.020)、供者血清肌酐≥177μmol/L(P=0.013)、热缺血时间≥15 min(P=0.041)、冷缺血时间≥12 h(P=0.025)及供者经历心肺复苏(P=0.001)有显著性差异。logistic多因素分析显示供者血清肌酐≥177μmol/L(OR=7.138,95%CI:1.418~35.937,P=0.017)、供者心肺复苏(OR=30.207,95%CI:3.653~111.778,P=0.001)及热缺血时间≥15 min(OR=7.762,95%CI:1.953~30.845,P=0.004)是DGF的独立预后因素。结论供者血清肌酐≥177μmol/L、供者经历心肺复苏及热缺血时间≥15 min是导致CDCD发生DGF的预后因素。     

体重指数对肾移植近期预后的影响:附单中心1041例报告

目的探讨体重指数(BMI)对肾移植术后患者近期预后的影响。方法回顾性分析2009年3月至2013年3月在解放军第309医院器官移植研究所首次行肾移植手术的1 041例成年患者的临床资料。根据中国常用成人肥胖与超重标准将纳入的患者分为4组:BMI﹤18.5 kg/m2组(消瘦组)112例,BMI 18.5~23.9 kg/m2组(正常组)606例,BMI 24.0~27.9 kg/m2组(超重组)250例,BMI≥28.0 kg/m2组(肥胖组)73例。观察与比较4组患者术后1年的移植物功能延迟恢复(DGF)、急性排斥反应(AR)发生率,以及计算1年人、肾存活率。采用单因素和多因素Logistic回归法分析BMI与DGF发生的关系,以探讨不同BMI值对DGF的影响。结果随访1年,肥胖组DGF的发生率明显高于正常组和消瘦组(均为P﹤0.05),但术后AR的发生率及术后1年人或肾存活率比较差异无统计学意义(均为P0.05)。单因素分析显示肥胖增加肾移植术后发生DGF的风险(OR为1.33,P﹤0.05)。多因素分析显示超重与肥胖均为肾移植术后发生DGF的独立危险因素(OR分别为1.56、1.37,均为P﹤0.05)。结论超重与肥胖增加术后DGF风险,但不增加术后AR发生率,亦不影响术后近期人、肾存活率。     

影响肝移植术后早期移植物功能障碍的危险因素分析

目的分析影响肝移植术后发生早期移植物功能障碍(EAD)的危险因素,并探讨其预防方法。方法回顾性分析2015年1月1日至2019年06月31日中山市人民医院进行肝移植患者112例,剔除资料不全者,纳入109例患者资料进行研究,对可能影响肝移植术后EAD发生的因素进行单因素和多因素logistic回归分析,并对多因素logistic回归分析结果行ROC曲线分析。结果供体术前乳酸(LAC)、供体年龄、受体身体质量指数(BMI)、受体术前白细胞(WBC)、受体术后淋巴细胞百分比(LYMPH%)、受体术后中性粒细胞/淋巴细胞比值(NLR)、供肝冷缺血时间与非EAD组之间存在差异(P0.05),其中受体BMI、供体术前LAC和供肝冷缺血时间是肝移植术后发生EAD的独立危险因素(P0.05)。结论肝移植术后影响EAD发生的危险因素包括供肝冷缺血时间(313.50 min)供体术前LAC、供体年龄、受体BMI、受体术前WBC、受体术后LYMPH%、受体术后NLR,其中受体BMI、供体术前LAC和供肝冷缺血时间(313.50 min)是独立的危险因素。     

脑死亡后器官捐献肾移植术后泌尿系感染危险因素的单中心临床研究

目的 探讨脑死亡后器官捐献肾移植术后受者发生泌尿系感染的独立危险因素，为受者泌尿道感染制定相应预防和控制措施提供理论依据。方法 回顾性分析2021年1月—2021年12月于北部战区总医院器官移植中心行同种异体的100例肾移植患者的临床资料，根据患者术后3个月内是否发生泌尿系感染分为感染组(26例)和非感染组(74例),采用单因素和多因素分析寻找脑死亡后器官捐献肾移植术后受者发生泌尿系感染的影响因素。结果 肾移植术后3个月内泌尿系感染的发生率为26%(26例)。单因素分析结果显示：性别、术后尿瘘、术后尿管留置时间及术后双J管留置时间是脑死亡后器官捐献肾移植术后受者泌尿系感染的影响因素(P<0.05);运用前进法逐步回归分析得出，术后双J管留置时间(OR=1.086,95%CI:1.003～1.177,P=0.042)及术后尿管留置时间(OR=4.687,95%CI:2.064～10.645,P<0.010)。是脑死亡后器官捐献肾移植术后受者出现泌尿系感染的独立危险因素(P<0.05)。结论 术后尿管留置及术后双J管留置时间长会增加脑死亡后器官捐献肾移植术后受者发生泌尿系...     

Nomogram for predicting the likelihood of delayed graft function in adult cadaveric renal transplant recipients

Delayed graft function (DGF) is the need for dialysis in the first week after transplantation. Studied were risk factors for DGF in adult (age >/=16 yr) cadaveric renal transplant recipients by means of a multivariable modeling procedure. Only donor and recipient factors known before transplantation were chosen so that the probabilities of DGF could be calculated before transplantation and appropriate preventative measures taken. Data on 19,706 recipients of cadaveric allografts were obtained from the United States Renal Data System registry (1995 to 1998). Graft losses within the first 24 h after surgery were excluded from the analysis (n = 89). Patients whose DGF information was missing or unknown (n = 2820) and patients missing one or more candidate predictors (n = 2951) were also excluded. By means of a multivariable logistic regression analysis, factors contributing to DGF in the remaining 13,846 patients were identified. After validating the logistic regression model, a nomogram was developed as a tool for identifying patients at risk for DGF. The incidence of DGF was 23.7%. Sixteen independent donor or recipient risk factors were found to predict DGF. A nomogram quantifying the relative contribution of each risk factor was created. This index can be used to calculate the risk of DGF for an individual by adding the points associated with each risk factor. The nomogram provides a useful tool for developing a pretransplantation index of the likelihood of DGF occurrence. With this index in hand, better informed treatment and allocation decisions can be made.     

Immunologic and nonimmunologic factors: different risks for cadaver and living donor transplantation

BACKGROUND: There is a debate about the relative contribution of immunologic (rejection) and nonimmunologic (limited nephron mass) factors in long-term graft survival. METHODS: Using multivariate analysis, we studied the association of the following variables with outcome: delayed graft function (DGF), acute rejection, recipient race (black vs. nonblack), donor age (<50 vs. > or =50), donor race, and donor and recipient gender. Because of the association between DGF and rejection, recipients were grouped as follows: DGF, rejection; DGF, no rejection; no DGF, rejection; no DGF, no rejection. Data were analyzed on 1199 first kidney transplants in adults (752 living donor, 447 cadaver donor) done between January 1, 1985 and December 31, 1996. Two analyses were done: first, all transplants; second, only those with > or =1 year survival. For both, there was no difference in risk factors if death with function was or was not censored. RESULTS: For all cadaver transplant recipients, risk factors were acute rejection, DGF plus rejection, black recipient race, and donor age > or =50. For living donor recipients, only acute rejection was a risk factor. When only 1-year graft survivors were considered, risk factors were the same: for cadaver recipients, risk factors were acute rejection, DGF plus rejection, black recipient race, and donor age > or =50; for living donor recipients the risk factor was rejection. CONCLUSION: We found immunologic factors (rejection with or without DGF) to be significant in both living donor and cadaver donor transplants. Nonim. munologic factors (donor age, recipient race) were significant only in cadaver donor transplants.     

Major effects of delayed graft function and cold ischaemia time on renal allograft survival.

BACKGROUND: There is mounting evidence from experimental and clinical studies that the quality of organs from cadaver donors may be influenced by events occurring around the time of brain death, and that these may affect transplant outcome. The aim of this study is to investigate the influence of donor factors on renal allograft outcome in a homogeneous cohort of 518 patients transplanted in a single centre over a 9 year period. METHODS: Endpoints of the study were delayed graft function (DGF), acute rejection (AR), 1 year graft survival and long-term survival of those grafts that reached 1 year. Multivariate analysis was performed to determine factors that may have influenced the graft outcome indicators. RESULTS: DGF was the major predictor of graft failure overall with cold ischaemia time (CIT) as an important independent factor. The level of histocompatibility did not influence graft survival. DGF was the major factor affecting 1 year graft survival (P<0.0005) with effects persisting beyond 1 year. DGF was significantly influenced by CIT, donor age, female kidney into male recipient and donor creatinine (P<0.05). Other donor factors and factors associated with donor management were not risk factors for DGF, rejection episodes or graft survival. The risk factors for a number of AR episodes were HLA-DR mismatch and DGF (P<0.005). When grafts surviving for 1 year were considered, only CIT, recipient age and creatinine at 1 year (P<0.05) were found to affect graft survival significantly. CONCLUSIONS: The results of this analysis of well-matched transplant recipients show that CIT and DGF are the most important predictors of poor short and long-term graft survival. Therefore, in order to improve the long-term survival of renal allografts efforts should focus on limiting CIT and the damage that occurs during this period and on improving our understanding of DGF.     

Posttransplantation acute tubular necrosis: risk factors and implications for graft survival

Previous studies aimed at identifying the causes, risk factors, and outcome of kidney transplant recipients with delayed graft function (DGF) have yielded controversial results. We retrospectively analyzed the causes and risk factors for DGF in 263 cadaveric kidney transplantations from November 1988 to March 1997 in one center. Causes of DGF were assessed by postoperative graft evolution and graft biopsy. Univariate and multivariate analysis were used to investigate the risk factors for DGF induced by acute tubular necrosis (ATN). Seventy-six patients (29%) had DGF, which was caused by ATN in 70 patients (92.1%) and acute rejection (AR) in 6 patients (7.9%). Therefore, we focused on risk factors and consequences for ATN-induced DGF. In monofactorial analysis, ATN was significantly associated with greater weight and presence of an atheromatous disease in both donor and recipient. Other risk factors for ATN were older age of donor, recipient American Society of Anesthesiology (ASA) physical status category IV, cold ischemia time (CIT), and transplantation using the right kidney. The multivariate analysis showed that donor and recipient weight, donor age, transplantation using the right kidney, preservation in Eurocollins solution, ASA score, and CIT were associated with ATN. The incidence of rejection and renal function were not different at 3 months or 1 and 5 years. ATN is the main cause of DGF in kidney transplant recipients. ATN is caused by donor and recipient vascular background, grafting the right kidney, and CIT. ATN does not appear to have an adverse effect on long-term kidney function.     

The impact of obesity in renal transplantation: an analysis of paired cadaver kidneys

BACKGROUND: Previous studies indicate that obesity is a risk factor in renal transplantation. However, these analyses did not control for variable donor factors that may strongly influence outcome. To control for donor variables such as age, cause of death, procurement techniques, preservation methods, cold ischaemia time and implantation technique, we analysed patient and graft survival in recipients of paired kidneys, derived from the same procurement procedure, preserved in the same manner, subjected to similar cold ischaemia time and implanted by the same surgical team. Between June 1992 and August 1999, 28 procurement procedures provided kidneys which were transplanted into one obese and one non-obese recipient. Body mass index (BMI) was calculated as kg/m2. Recipients were classified as obese (BMI > 30) or non-obese (BMI < 30). Immunotherapy for all recipients consisted of a triple therapy regimen of cyclosporine or prograf, azathioprine or cellcept, and prednisone. Patients with delayed graft function (DGF), defined as the need for dialysis within 72 h of the transplant procedure, were treated with anti-thymocyte globulin (ATG) or thymoglobulin (TMG) induction for 5-7 d. The rate of DGF (7.1 versus 10.7%) and acute rejection (39.3 versus 35.7%) were similar in the obese and non-obese recipient groups. Patient survival was similar at 1, 3 and 5 yr in both groups. In addition, graft survival was similar at 1 yr. However, a trend toward decreased medium-term graft survival, which reached significance at 5 yr, was observed in the obese group. Furthermore, mean serum creatinine at 1 yr was higher in the obese group (2.0) compared with the non-obese group (1, 4) (p=0.12). This analysis of paired cadaver kidneys indicated that obesity is not a risk factor for DGF, acute rejection, and 1-yr graft survival. However, a decreased medium- and long-term graft survival trend, which reached statistical significance at 5 yr, was observed in obese recipients.     

Effect of brain-dead donor resuscitation on delayed graft function: results of a monocentric analysis

BACKGROUND: We have previously shown that a delayed graft function (DGF) longer than 6 days was a crucial threshold for long-term graft outcome. The aim of this study was to analyze the correlation of DGF >or=6 days with brain-dead donor variables, including those related to resuscitation, in a population of 262 consecutive brain-dead donors from 1990 to 2003. METHODS: We used a marginal logistic model in which DGF was considered as a binary variable with a cutoff of 6 days. RESULTS: Monovariate analysis of donor parameters showed that male, age above 35 years, primary history of hypertension, hydroxyethyl starch (HES) fluid greater than 1500 mL or epinephrine infusion during resuscitation were risk factors for prolonged DGF. The multivariate logistic regression model showed that epinephrine use during donor resuscitation (P<0.001, odds ratio [OR]=4.35), cold ischemia time (CIT) >or=16 hr (P=0.01, OR=2.16), and recipient age >55 years (P=0.003, OR=2.75), were associated with a risk of prolonged DGF. A long stay (>40 hr) in intensive care and a large volume of colloids (>1250 mL, except HES) correlated with a lower risk of DGF. CONCLUSION: Our study shows an impact for only a limited number of brain dead donor resuscitation parameters on DGF duration. We also show that CIT has a much lower threshold (<16 hr) for DGF risk than previously described. Importantly, we show that recipient age is clearly a major independent risk factor for prolonged DGF, whereas donor age seems to act mostly as a dependent risk factor.     

Peri‐operative hyperglycemia is associated with delayed graft function in deceased donor renal transplantation

Increasing evidence indicates that recipient diabetes is a risk factor for delayed graft function (DGF) after renal transplant and that peri‐operative hyperglycemia increases ischemia–reperfusion injury. To evaluate whether peri‐operative hyperglycemia as measured in the post‐anesthesia care unit (PACU) after transplant is a risk factor for DGF, we retrospectively reviewed 976 adult recipients of deceased donor renal transplants between January 1, 1997 and December 1, 2004. Logistic regression was used to evaluate risk factors for DGF. In our final multivariate model, recipient blood glucose level in the PACU (odds ratio [OR] 1.10 per 25 unit increase, 95% confidence interval (CI) 1.14–2.46, p = 0.03) was a statistically significant predictor of DGF along with donor age (OR 1.02, 95% CI 1.01–1.03, p < 0.01), cold ischemia time (OR 1.04, 95% CI 1.02–1.07, p < 0.01), recipient male gender (OR 1.68, 95% CI 1.14–2.68, p = 0.01), and a panel‐reactive antibody >30% (OR 1.92, 95% CI 1.20–3.05, p = 0.01). We conclude that recipient blood glucose measured in the PACU is associated with DGF and begs the question of whether improved peri‐operative glucose control will decrease the incidence of DGF.     

Arteriolar hyalinization predicts delayed graft function in deceased donor renal transplantation

Delayed renal graft function (DGF) remains a largely unpredictable and burdensome consequence of deceased donor renal transplantation. There is growing evidence that histologic and molecular analyses of baseline donor kidney biopsies can predict both short- and long-term graft outcome. We performed histologic analyses of 172 preimplantation kidney biopsies to determine reliable histologic risk factors for DGF. Fifty-six recipients presented a DGF (incidence 32%). Univariate analysis revealed that arteriolar hyalinization (P=0.019), arterial intima fibrosis (0.004), donor age (P=0.001), duration of cold ischemia time (P=0.001), and recipient age (P=0.001) were significantly associated with DGF. Multivariate analysis revealed that the only independent histologic factor was arteriolar hyalinization (P=0.036). This histologic predictive factor, together with previously identified clinical risk factors, could guide clinical decisions regarding use, allocation, or immunosuppression protocols for minimization of DGF.