腎移植術中血流監測對早期移植腎功能之影響分析
李允仁、劉冠麟、林國仁、林志德、江仰仁、朱聖賢、謝明里、王敘涵
林口長庚紀念醫院外科部 泌尿科系
The influence of immediate graft blood flow on early graft function
Yun-Ren Li, Kuan-Lin Liu, Kuo-Jen Lin; Chih-Te Lin; Yang-Jen Chiang, Sheng-Hsien Chu, Ming-Li Hsieh, Hsu-Han Wang
Department of Urology, Chang-Gung Memorial Hospital, Taoyuan, TAIWAN
Purpose: The aim of this study is to evaluate the impact of intraoperative allograft vascular flow on the early kidney graft function.
Materials and Methods: A total of 47 patients underwent kidney transplantation from January 2017 to June 2019 at Linkou Chang Gung Memorial Hospital. The majority anastomosis of graft vessels were done with end-to-side manner to the external iliac vessels. Real-time graft blood flow was measured with transit time flowmeter(Transonic HT353) after ureteroneocystostomy. Graft arterial and venous blood glow was measured separately. The early outcomes including postoperative creatinine level and daily urine output were analized accordingly.
Results: The median age was 45.7(13-68) years and 22(46.8%) patients were female. Among the 47 recipients, 35 received kidneys from living related donors and 12 from deceased donors. The mean renal artery blood flow was 450.74 ml/min (median=425) and the mean renal vein flow was 541.49 ml/min (median=470). With multivariate regression on creatinine declining ratio, graft arterial blood flow has significant impact on day 2 and 3 while graft venous blood flow was significant on day 1, 2, 3, 7 and 30 (p<0.05). As for urine output, graft arterial flow was significantly associated with more urine output on day 0-1 and day 0-2 but not any further after day 3. Graft venous flow had no impact on urine amount postoperatively.
We performed receiver operating characteristic (ROC) analysis to exam the relationship between CDR and graft vessel blood flow with mean CDR as the cut-off point. Graft arterial blood flow showed acceptable discrimination on CDR2 (AUC=0.736, p=0.006) and CDR3 (AUC=0.753, p=0.004) when arterial blood flow achieved 375ml/min. The positive predictive value (PPV) were 0.758 and 0.828 while negative predictive value (NPV) were 0.778 and 0.723. Graft venous blood flower also showed acceptable discrimination on CDR2 (AUC=0.718, p=0.011) and CDR3 (AUC=0.713, p=0.015) when venous blood flow reached 455ml/min. The PPV were 0.7531 and 0.759 while NPV were 0.667 and 0.611, respectively.
Conclusion: Graft arterial blood flow was significantly associated with creatinine declining ratio and urine output amount whilst graft venous blood flow showed more persistent association with creatinine declining ratio during early postoperative phase