摘要
目的 分析供者移植前进行血液透析对肾移植受者及移植肾预后的影响.方法 收集武汉大学人民医院器官移植科2020年1月至2023年6月期间进行器官捐献的289例供体的临床资料,进行回顾性队列研究.纳入期间所有术前进行血液透析的"中国三类"供体一共21例,对应受体40例.并采用倾向得分临近匹配法,根据(接受透析供体的受体数量:接受非透析供体的受体数量)=(1:2)的比例,纳入同期接受未透析供肾的受者和对应的供者作为对照,收集与分析相应供受体的临床资料.比较透析和非透析供体之间及对应受体的临床资料是否存在统计学差异,以此分析受体的预后情况.结果 根据倾向得分,实际匹配纳入同期接受未透析供肾的受者共57例,他们对应的供者为50例.配对后组间基线资料差异无统计学意义(P＞0.05),具有可比性.未透析的供体和透析的供体在捐献前的血清肌酐、尿素氮、预估肾小球滤过率(estimated glomerular filtration rate,EGFR)、急性肾损伤(acute kidney injury,AKI)阳性比例等指标均有统计学意义(P＜0.001,P=0.013,P＜0.001,P＜0.001).两组受体在术后第1天血清肌酐水平上具有统计学意义(P=0.019),而术后肾功能延迟恢复(delayed graft function,DGF)发生率没有统计学意义(P=0.289).两组受者中,均各有13例发生DGF(13/40;13/57),无发生移植物原发性无功能(primary nonfunction,PNF)病例.结论 供者术前接受临时透析与移植术后受者发生DGF并无直接相关性,可以考虑作为边缘供肾在临床使用.
Abstract
Objective To analyze the effect of pre-transplant donor kidney hemodialysis on the prognosis of recipients and grafts.Methods The clinical data of 289 donors who underwent organ donation in the Department of Organ Transplantation of Renmin Hospital of Wuhan University from January 2020 to June 2023 were collected and a retrospective cohort study was conducted.A total of 21"Chinese Class Ⅲ"donors who underwent preoperative hemodialysis and 40 corresponding recipients were included in the study.Propensity score near matching method was used to select non-dialysis donors and their corresponding donors as controls according to the ratio(number of recipients receiving dialysis donors:number of recipients receiving non-dialysis donors)=(1:2).Clinical data were collected and analyzed.Clinical data of the corresponding donors and recipients were collected and analyzed.Clinical data of corresponding recipients were collected and analyzed.The general data of dialysis and non-dialysis donors and their corresponding recipients were compared to analyze the prognosis of recipients.Results According to the propensity score,a total of 57 recipients who received non-dialysis donor kidneys during the same period were matched,and their corresponding donors were 50.There was no significant difference in baseline data between the two groups after matching(P＞0.05).There were significant differences in serum creatinine,urea nitrogen,estimated glomerular filtration rate(EGFR)and AKI positive rate between non-dialysis donors and dialysis donors before donation(P＜0.001,P=0.013,P＜0.001,P＜0.001).The difference in serum creatinine level on the first day after transplantation between the two groups was statistically significant(P=0.019),while the incidence of delayed graft function(DGF)was not statistically significant(P=0.289).There were 13 cases of DGF(13/40;13/57),and no PNF occurred.Conclusion There is no direct correlation between temporary dialysis before transplantation and DGF after transplantation.It can be considered as a marginal donor kidney in clinical application.
维普
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