不同延遲腎功能定義對預後之影響分析

李允仁、劉冠麟、林國仁、林志德、潘柏諺、江仰仁、朱聖賢、王敘涵

林口長庚紀念醫院外科部 泌尿科系

Comparing the Different Definition of Delayed Graft Function after Renal Transplantation

Yun-Ren Li, Kuan-Lin Liu, Kuo-Jen Lin, Chih-Te Lin, Pai-Yen Pan, Yang-Jen Chiang, Sheng-Hsien Chu, Hsu-Han Wang

Department of Urology, Chang-Gung Memorial Hospital, Taoyuan, TAIWAN

Purpose: Delayed graft function (DGF) is difficult to define precisely, and several classifications are used currently. We analyze our outcomes to assess whether any of 6 different currently used definitions of DGF predict kidney graft survival and function for living and deceased donor kidneys.

Materials and Methods: A total of 117 patients underwent kidney transplantation from January 2017 to February 2022 at Linkou Chang Gung Memorial Hospital were reviewed. The definitions of DGF were based on dialysis requirements, creatinine changes, or both. The relationship of DGF to graft function and graft survival was determined.

Results: The median age was 44 years and 76(47.5%) patients were female. Among the 117 recipients, 79 received kidneys from living related donors and 38 from deceased donors. The mean HLA mismatch number is 2.3 and mean graft arterial and venous blood flow were 480.62, 506.15 ml/min, respectively. The incidence of DGF varied widely depending on the definition used (living donor: 6.3%-29.1%; deceased donor: 13.2%-55.3%). For kidney from living donors, as defined in 5 of 6 different ways, was associated with poorer 1-year estimated glomerular filtration rate (eGFR) and 2 of them associated with inferior graft survival. However, for deceased kidneys, development of DGF had a trend of poorer 1-year estimated glomerular filtration rate (without Statistical significance) and no definition of DGF was associated with impaired graft survival.

Conclusion: DGF on living related donors is associated with poor 1-year eGFR and inferior graft survival. Current definition of DGF seems to be more suitable to measure living donor kidney transplantation.