急性肾损伤供肾对肾移植受者预后影响分析

目的分析发生急性肾损伤(AKI)供肾对肾移植受者及移植肾预后的影响。 方法选取2015年1月至2021年9月武汉大学人民医院器官移植科71例供肾捐献前发生AKI供者(AKI 1、2和3期分别为31、16和18例)及78例非AKI供者，AKI组对应受者136例(AKI 1、2和3期供者对应受者分别为70、32和34例)，非AKI组对应受者154例。采用成组t检验或单因素方差分析比较正态分布计量资料。计数资料采用卡方检验或Fisher确切概率法比较。采用Kaplan-Meier法绘制受者/移植肾生存曲线并采用log-rank检验进行比较。P<0.05为差异有统计学意义。 结果AKI组供者入院时血清肌酐以及供肾获取时血清肌酐、尿素氮、血红蛋白和尿蛋白阳性比例分别为(91±51)μmol/L、(206±126)μmol/L、(17±16)mmol/L、(121±28)g/L、53.5%(38/71)，非AKI组分别为(66±33)μmol/L、(53±24)μmol/L、(9±4)mmol/L、(108±22)g/L和21.8%(17/78)，差异均有统计学意义(t＝－3.488、－10.096、－0.432和－3.066，χ²＝16.065，P均<0.05)。AKI 1期、AKI 2期和AKI 3期供者入院时血清肌酐以及供肾获取时血清肌酐和白蛋白差异均有统计学意义(F＝8.275、15.012和3.840，P均<0.05)。非AKI组对应受者术后1个月血清肌酐、术后移植肾功能延迟恢复发生及移植肾存活比例分别为(106±47)μmol/L、9.1%(14/154)和98.1%(151/158)，AKI组对应受者分别为(126±82)μmol/L、25.0%(34/136)和86.8%(118/136)，差异均有统计学意义(t＝－2.561，χ²＝13.234和9.445，P均<0.05)。AKI与非AKI组供者对应受者移植肾存活率差异有统计学意义(χ²＝9.445，P<0.05)；AKI与非AKI组供者对应受者生存率差异无统计学意义(χ²＝3.107，P>0.05)。不同AKI分期供者对应受者移植肾及受者存活率差异均无统计学意义(χ²＝1.643和1.257，P均>0.05)。 结论高分期AKI供者供肾经过积极维护能达到与低分期AKI供者供肾相似的移植效果，高分期AKI供者供肾经专业评估筛选后可作为扩大供肾来源的途径。

Effects of donor kidneys with acute kidney injury on the prognosis of recipients after kidney transplantation

ObjectiveTo investigate the effects of donor kidneys with acute kidney injury (AKI) on the prognosis of kidney transplant recipients and transplanted kidneys . MethodsA total of 71 donors with AKI before kidney donation (AKI stages 1, 2 and 3 were 31, 16 and 18 cases, respectively) and 78 donors without AKI were selected from the Organ Transplantation Department of the Renmin Hospital of Wuhan University from January 2015 to September 2021. There were 136 recipients in the AKI group (70, 32, and 34 recipients in AKI stages 1, 2, and 3), and 154 recipients in the non-AKI group. Group t test or One-Way ANOVA were used to compare the normal distribution measurement data. Chi-square test or Fisher′s exact probability methods were used to compare the count data. Kaplan-Meier method was used to plot the recipient/graft survival curve and log-rank test was used for comparison. P<0.05 was considered statistically significant. ResultsIn the AKI group, the serum creatinine at admission, and serum creatinine, urea nitrogen, hemoglobin, and the percentage of positive urine protein at donor kidney acquisition were (91±51) μmol/L, (206±126) μmol/L, (17±16) mmol/L, (121±28) g/L and 53.5% (38/71), respectively; and those were (66±33) μmol/L, (53±24) μmol/L, (9±4) mmol/L, (108±22) g/L and 21.8% (17/78) in Non-AKI group, the differences were statistically significant (t=-3.488, -10.096, -0.432 and -3.066, χ²=16.065, all P<0.05). There were significant differences in serum creatinine at admission, and serum creatinine and albumin at donor kidney acquisition among donors with AKI stage 1, AKI stage 2 and AKI stage 3 (F=8.275, 15.012 and 3.84, all P<0.05). In the non-AKI group, serum creatinine at 1 month after surgery, the percentage of delayed graft function, transplanted kidneys survival rate were (106±47) μmol/L, 9.1% (14/154) and 98.1% (151/158), respectively; and those were (126±82) μmol/L, 25.0% (34/136) and 86.8% (118/136) in AKI group, and the differences were statistically significant (t=-2.561, χ²=13.234 and 9.445, all P<0.05). There was significant difference in the survival rate of corresponding transplanted kidneys for the AKI group and the non-AKI group (χ²=9.445, P<0.05). There was no statistically significant difference in the survival rate of corresponding recipients for the AKI group and the non-AKI group (χ²=3.107, P>0.05). There was no significant difference in the survival rate of corresponding transplanted kidneys and recipients for donors with different AKI stages (χ²=1.643 and 1.257, all P>0.05). ConclusionsAfter active organ maintenance, donor kidneys from high-stage AKI donors can achieve transplantation effects similar to those from low-stage AKI donors. Donor kidneys from high-stage AKI donors can be used as a way to expand donor kidney sources after professional evaluation and screening.