Perioperative factors associated with delayed graft function in renal transplant patients

ABSTRACT Introduction: Successful renal transplant and consequent good graft function depend on a good surgical technique, an anesthetic that ensures the hemodynamic stability of the receiver, and appropriate conditions of graft and recipient. Several factors can interfere with the perfusion of the graft and compromise its viability. The objective of this study was to evaluate perioperative factors associated with delayed graft function (DGF) in renal transplantation patients. Methods: This is a historical cohort study of patients who underwent renal transplantation between 2011 and 2013. Three hundred and ten transplants were analyzed. DGF was defined as the need for dialysis during the first week post-transplant. Logistic regression with a stepwise technique was used to build statistical models. Results: Multivariate analysis revealed the following risk factor for DGF: combined anesthesia technique (OR = 3.81, 95%CI, 1.71 to 9.19), a fluid regimen < 50 mL·kg-1 (OR = 3.71, 95%CI, 1.68 to 8.61), dialysis for more than 60 months (OR = 4.77, 95%CI, 1.93 to 12.80), basiliximab (OR = 3.34, 95%CI, 1.14 to 10.48), cold ischemia time > 12 hour (OR = 5.26, 95%CI, 2.62 to 11.31), living donor (OR = 0.19, 95%CI, 0.02 to 0.65), and early diuresis (OR = 0.02, 95%CI, 0.008 to 0.059). The accuracy of this model was 92.6%, calculated using the area under the ROC curve. The incidence of DGF in the study population was 76.1%. Conclusions: Combined anesthesia technique, dialysis for more than 60 months, basiliximab, and cold ischemia time > 12 hours are risk factor for DGF, while liberal fluid regimens and kidneys from living donors are protective factors.

摘要
引言：成功的肾移植及术后良好的移植物功能，有赖于精湛的外科操作、可保障受者血流动力学稳定的麻醉方案，以及移植物与受者的适宜状态。诸多因素可干扰移植物灌注并损害其存活能力。本研究旨在评估肾移植患者术后移植物功能延迟恢复（delayed graft function, DGF）相关的围手术期因素。
方法：本研究为2011至2013年间接受肾移植患者的历史性队列研究，共纳入310例移植病例进行分析。移植物功能延迟恢复定义为移植术后第一周内需接受透析治疗。本研究采用逐步法logistic回归构建统计模型。
结果：多因素分析结果显示，与DGF相关的危险因素包括：联合麻醉方案（比值比OR=3.81，95%置信区间CI：1.71~9.19）、液体输注量<50 mL·kg⁻¹（OR=3.71，95%CI：1.68~8.61）、透析时长超过60个月（OR=4.77，95%CI：1.93~12.80）、使用巴利昔单抗（OR=3.34，95%CI：1.14~10.48）、冷缺血时间>12小时（OR=5.26，95%CI：2.62~11.31）；而活体供肾（OR=0.19，95%CI：0.02~0.65）与早期利尿（OR=0.02，95%CI：0.008~0.059）为保护因素。本模型的受试者工作特征曲线（Receiver Operating Characteristic curve, ROC）下面积为0.926，诊断准确率达92.6%。本研究人群中DGF的发生率为76.1%。
结论：联合麻醉方案、透析时长超过60个月、使用巴利昔单抗及冷缺血时间>12小时为DGF的危险因素，而宽松液体输注方案、活体供肾与早期利尿为DGF的保护因素。