The effect of intraoperative inosine infusion on transplant outcomes in deceased-donor kidney transplant recipients

It is unknown when inosine was first employed as a renoprotective agent in the context of kidney transplantation procedures. However, there is no clinical evidence to support a protective role of inosine. The aim of this study was to investigate the effect of inosine on graft recovery. Data related to donors and recipients were retrieved from relevant records between 2015 and 2023. A total of 1138 kidney transplant cases were identified, including 1005 recipients who received a bolus of 1000 mg inosine and 133 recipients who did not receive inosine during transplantation surgery. The endpoints of the analysis included recipient recovery after transplantation as assessed by delayed graft function (DGF), peak estimated glomerular filtration rate (eGFR) after transplantation, and unfavorable graft function recovery. Given the high dimensionality of the donor and recipient variables, propensity score weighting analyses were conducted. No significant differences in the risk of DGF (OR = 0.80 [0.52, 1.22], <i>p</i> = 0.301), unfavorable graft function recovery (OR = 0.95 [0.61, 1.51], <i>p</i> = 0.842) or peak eGFR after transplantation (β = 1.61 [−4.33, 7.56], <i>p</i> = 0.594) were observed between the inosine and no-inosine groups <i>via</i> overlap weighting analysis. Intraoperative infusion of 1000 mg of inosine has no effect on graft recovery after kidney transplantation. Therefore, the practice of using inosine during kidney transplantation surgery is not supported by evidence.

目前尚不清楚肌苷首次被用作肾移植术中肾保护剂的具体时间。然而，目前尚无临床证据支持肌苷具有肾保护作用。本研究旨在探讨肌苷对移植肾恢复的影响。研究数据提取自2015年至2023年的相关临床记录，涵盖供者与受者相关信息。最终纳入1138例肾移植病例，其中1005例受者在移植术中接受了1000mg肌苷弹丸式给药，其余133例受者未接受肌苷干预。本研究的分析终点包括：通过移植肾功能延迟恢复（delayed graft function, DGF）评估的受者术后恢复情况、术后估算肾小球滤过率（estimated glomerular filtration rate, eGFR）峰值，以及移植肾功能不良恢复结局。考虑到供者与受者变量存在高维度特征，本研究采用倾向得分加权分析方法。通过重叠加权分析结果显示，肌苷组与非肌苷组在DGF发生风险（比值比OR=0.80，95%置信区间[0.52, 1.22]，p=0.301）、移植肾功能不良恢复结局风险（OR=0.95，95%置信区间[0.61, 1.51]，p=0.842）以及术后eGFR峰值（回归系数β=1.61，95%置信区间[-4.33, 7.56]，p=0.594）方面均无显著统计学差异。术中给予1000mg肌苷对肾移植术后移植肾恢复无显著影响。因此，现有证据不支持在肾移植术中使用肌苷的临床实践。