肝移植中急性肾损伤的比较研究:循环死亡后捐献与脑死亡后捐献的比较研究

IF 1.1 4区 医学 Q3 SURGERY Annals of Transplantation Pub Date : 2024-07-30 DOI:10.12659/AOT.944077
Benedikt Hilger, Katja Frick, Rolf Erlebach, Philipp Dutkowski, Rea Andermatt, Sascha David, Reto A Schüpbach, Stephanie Klinzing
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The secondary outcome was dynamics of AKI and kidney replacement therapy (KRT) during the first postoperative week and on postoperative day 30. Incidence and resolution from AKI and KRT and patient survival (PS) 30 days after OLT were compared between the DCD and DBD recipients. RESULTS MAKE-30 incidence after OLT was comparable in DCD (n=27, 40%) vs DBD (n=41, 27%) recipients (risk ratio 1.49 [95% CI 1.01, 2.21], p=0.073). AKI incidence was comparable in DCD (n=58, 94%) vs DBD (n=95, 82%) recipients (risk ratio 1.14 [95% CI: 1.03, 1.27], P=0.057). Overall, 40% (n=88) of patients required KRT, with no difference between DCD (n=27, 40%) vs DBD (n=61, 40%) recipients (risk ratio 1.00 [95% CI 0.71, 1.43], P>0.999). Resolution of AKI by day 30 was lower in DCD (n=29, 50%) than in DBD (n=66, 69%) recipients (risk ratio 0.71 [95% CI: 0.53, 0.95], P=0.032). Survival after 30 days (DCD: n=64, 94% vs DBD: n=146, 95%, risk ratio 0.99 [95% CI 0.93, 1.06], P>0.999) was also comparable. 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引用次数: 0

摘要

背景:正位肝移植(OLT)后的急性肾损伤(AKI)是发病率和死亡率的主要原因。循环死亡后捐献(DCD)是为了增加器官库。据报道,DCD和脑死亡(DBD)后捐献OLT的手术并发症不相上下,但这两组患者的肾脏不良事件却存在知识空白。材料与方法 在这项回顾性队列研究中,154 名患者接受了 DBD,68 名患者接受了 DCD 器官(2016-2020 年)。主要结果是 30 天内发生重大肾脏不良事件(MAKE-30)。次要结局是术后第一周和术后第30天的AKI和肾脏替代治疗(KRT)动态。比较了 DCD 和 DBD 受者的 AKI 和 KRT 发生率、缓解情况以及 OLT 术后 30 天的患者存活率(PS)。结果 DCD受者(n=27,40%)与DBD受者(n=41,27%)OLT后MAKE-30的发生率相当(风险比1.49 [95% CI 1.01, 2.21],P=0.073)。DCD(n=58,94%)与 DBD(n=95,82%)受者的 AKI 发生率相当(风险比 1.14 [95% CI: 1.03, 1.27],P=0.057)。总体而言,40%(88 人)的患者需要 KRT,DCD(27 人,40%)与 DBD(61 人,40%)受者之间没有差异(风险比 1.00 [95% CI 0.71, 1.43],P>0.999)。DCD受者(n=29,50%)第30天AKI缓解率低于DBD受者(n=66,69%)(风险比0.71 [95% CI: 0.53, 0.95],P=0.032)。30 天后的存活率(DCD:64 人,94% vs DBD:146 人,95%,风险比 0.99 [95% CI 0.93,1.06],P>0.999)也相当。结论 DBD 和 DCD-OLT 的 MAKE-30、短期肾功能结果和存活率没有显著差异。DCD受者第30天AKI缓解率低于DBD受者。
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Comparative Study of Acute Kidney Injury in Liver Transplantation: Donation after Circulatory Death versus Brain Death.

BACKGROUND Acute kidney injury (AKI) after orthotopic liver transplantation (OLT) contributes to morbidity and mortality. Donation after circulatory death (DCD) has been established to increase the pool of organs. While surgical complications are reported to be comparable in DCD and donation after brain death (DBD) OLT, there is a knowledge gap concerning adverse kidney events in these 2 groups. MATERIAL AND METHODS In this retrospective cohort study, 154 patients received a DBD and 68 received a DCD organ (2016-2020). The primary outcome was a major adverse kidney event within 30 days (MAKE-30). The secondary outcome was dynamics of AKI and kidney replacement therapy (KRT) during the first postoperative week and on postoperative day 30. Incidence and resolution from AKI and KRT and patient survival (PS) 30 days after OLT were compared between the DCD and DBD recipients. RESULTS MAKE-30 incidence after OLT was comparable in DCD (n=27, 40%) vs DBD (n=41, 27%) recipients (risk ratio 1.49 [95% CI 1.01, 2.21], p=0.073). AKI incidence was comparable in DCD (n=58, 94%) vs DBD (n=95, 82%) recipients (risk ratio 1.14 [95% CI: 1.03, 1.27], P=0.057). Overall, 40% (n=88) of patients required KRT, with no difference between DCD (n=27, 40%) vs DBD (n=61, 40%) recipients (risk ratio 1.00 [95% CI 0.71, 1.43], P>0.999). Resolution of AKI by day 30 was lower in DCD (n=29, 50%) than in DBD (n=66, 69%) recipients (risk ratio 0.71 [95% CI: 0.53, 0.95], P=0.032). Survival after 30 days (DCD: n=64, 94% vs DBD: n=146, 95%, risk ratio 0.99 [95% CI 0.93, 1.06], P>0.999) was also comparable. CONCLUSIONS MAKE-30, short-term renal outcome, and survival did not significantly differ between DBD and DCD-OLT. Resolution of AKI by day 30 was lower in DCD than in DBD recipients.

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来源期刊
CiteScore
2.50
自引率
0.00%
发文量
79
审稿时长
>12 weeks
期刊介绍: Annals of Transplantation is one of the fast-developing journals open to all scientists and fields of transplant medicine and related research. The journal is published quarterly and provides extensive coverage of the most important advances in transplantation. Using an electronic on-line submission and peer review tracking system, Annals of Transplantation is committed to rapid review and publication. The average time to first decision is around 3-4 weeks. Time to publication of accepted manuscripts continues to be shortened, with the Editorial team committed to a goal of 3 months from acceptance to publication. Expert reseachers and clinicians from around the world contribute original Articles, Review Papers, Case Reports and Special Reports in every pertinent specialty, providing a lot of arguments for discussion of exciting developments and controversies in the field.
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