Experimental and clinical transplantation : official journal of the Middle East Society for Organ Transplantation · 2015
Influence of Factors Associated With the Deceased-Donor on Kidney Transplant Outcomes.
СтатьяПоддержка исследования: вне правительства СШАНазвание и аннотация: Перевод в очереди
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Stolyar Alexey G, Budkar Ludmila N, Solodushkin Svyatoslav I, Iumanova Irina F
Аннотация
OBJECTIVES: We analyzed different donor characteristics to determine those that significantly affect patient and graft outcomes after kidney transplant.
MATERIALS AND METHODS: We conducted a retrospective analysis of patients who had received kidney transplants at our institution between 1990 and 2011 from deceased-donors. We tracked these patients until the end of 2014. Using univariate and multivariate analyses, we analyzed the following outcomes: patient status, graft status, chronic allograft nephropathy, and delayed graft function.
RESULTS: In 342 recipients, univariate analysis revealed donor-associated predictors of transplant outcomes. Recipients of kidneys from older donors showed longer time to creatinine normalization (P = .047). We found a partial correlation between donor diagnosis and the number of dialyses after surgery (excluding the effect of donor age), with patients receiving kidneys from donors who had cerebrovascular events having higher risk of delayed graft function (P = .03). Donors with shorter stays in intensive care units resulted in longer graft survival (P = .02), and vasopressor use by donors was associated with delayed graft function in recipients (P = .018). Low serum sodium levels in donors predicted worse survival of recipients and transplants (P = .015 and P = .048). The number of hemodialysis procedures after transplant was correlated with the donors ' creatinine level (P = .027). Insufficient daily dieresis of donor predicted worse graft survival (P = .04). Correlation analysis showed that a higher PCO2 level in donors was significantly associated with longer creatinine normalization time after kidney transplant (P = .001). Cox regression analysis detected 2 significant independent predictors of graft outcomes: duration of perfusion of donor kidney (P = .016) and length of intensive care unit stay of donor (P = .032), with improved prognosis associated with longer perfusion time and shorter time in intensive care unit.
CONCLUSIONS: The kidney donor has a direct effect on patient life expectancy.
MATERIALS AND METHODS: We conducted a retrospective analysis of patients who had received kidney transplants at our institution between 1990 and 2011 from deceased-donors. We tracked these patients until the end of 2014. Using univariate and multivariate analyses, we analyzed the following outcomes: patient status, graft status, chronic allograft nephropathy, and delayed graft function.
RESULTS: In 342 recipients, univariate analysis revealed donor-associated predictors of transplant outcomes. Recipients of kidneys from older donors showed longer time to creatinine normalization (P = .047). We found a partial correlation between donor diagnosis and the number of dialyses after surgery (excluding the effect of donor age), with patients receiving kidneys from donors who had cerebrovascular events having higher risk of delayed graft function (P = .03). Donors with shorter stays in intensive care units resulted in longer graft survival (P = .02), and vasopressor use by donors was associated with delayed graft function in recipients (P = .018). Low serum sodium levels in donors predicted worse survival of recipients and transplants (P = .015 and P = .048). The number of hemodialysis procedures after transplant was correlated with the donors ' creatinine level (P = .027). Insufficient daily dieresis of donor predicted worse graft survival (P = .04). Correlation analysis showed that a higher PCO2 level in donors was significantly associated with longer creatinine normalization time after kidney transplant (P = .001). Cox regression analysis detected 2 significant independent predictors of graft outcomes: duration of perfusion of donor kidney (P = .016) and length of intensive care unit stay of donor (P = .032), with improved prognosis associated with longer perfusion time and shorter time in intensive care unit.
CONCLUSIONS: The kidney donor has a direct effect on patient life expectancy.
Предметные рубрики MeSH
AdolescentAdultChildDelayed Graft FunctionFemaleGraft SurvivalHealth StatusHumansKaplan-Meier EstimateKidney DiseasesKidney TransplantationLife ExpectancyLogistic ModelsMaleMiddle AgedMultivariate AnalysisProportional Hazards ModelsRetrospective StudiesRisk FactorsRussiaTime FactorsTissue DonorsTreatment OutcomeYoung Adult