Related Study Of Delayed Graft Function Of Pediatric Renal Transplantation From Deceased Donor

BackgroundRenal transplantation is currently recognized as the best treatment for children with end stage renal disease(ESRD).Delayed graft function(DGF)is a common complication after kidney transplantation.The incidence rate of DGF fluctuates between 20% and 50% after the increasing utilization rate of deceased donor(DD)and expanded criteria deceased donor(ECD).Epidemiological studies suggest that DGF increases medical resources and costs,and is associated with poor graft prognosis,increasing the risk of graft loss and chronic allograft nephropathy(CAN).There are many risk factors of DGF.In adult recipient kidney transplantation,many studies have found that the risk factors of DGF include the last creatinine(> 1.5 mg/dL)、 non-traumatic brain death and cardio-pulmonary resuscitation(CPR)treatment before donor procurement,female donor,old donor(donor age),body mass index(BMI)of recipient and high level of panel-reactive antibody(PRA),re-transplantation,recipients over 50 years old(recipient age),prolonged cold ischemia time(CIT),warm ischemia time(WIT),etc.There are few studies on pediatric renal transplantation.Some studies on DGF selectively exclude children and consider children as high-risk groups.At present,a small number of studies show that donor age(>15 years old),donor brain death due to vascular causes,prolonged cold ischemia time(>24 hours),African-Americans recipient,absence of T-cell depletion induction therapy before operation,greater than 5 times random blood transfusion before operation,re-transplantation,HLA-DR mismatch are all risk factors for DGF in pediatric renal transplantation.With the DD developing in China,in order to make up for the shortage of organ transplant donors,increase the opportunities of recipients on waiting list,especially children,and application of standard death donors has become a trend.Long-term prognosis of pediatric renal transplantation is an important factor affecting children’s growth and development.Recognition of DGF risk factors is the key to improve the prognosis.This study analyzed the clinical data of 163 cases operated in the Department of Renal Transplantation,First Affiliated Hospital of Zhengzhou University,and explored the risk factors affecting the occurrence of DGF in pediatric kidney transplantation.In addition,the one-year recipient survival rate after kidney transplantation has been greatly improved in the past few years,but the improvement of long-term graft survival time is limited.Graft dysfunction after transplantation needs early diagnosis and treatment such as immune adjustment to avoid graft loss.Glomerular filtration rate(GFR)is currently recognized as the best indicator for evaluating renal function.In clinic,the level of blood urea nitrogen(BUN)and serum creatinine(sCr)are often measured to indirectly reflect the level of GFR.However,they are vulnerable to age,sex,diet and muscle condition.The accurate prediction of GFR is essential to assess renal function and disease progression.Studies have shown that serum low molecular weight proteins,such as cystatin C(Cys-C),beta 2-microglobulin(β2-MG),as markers of renal function,seem to be easier to detect GFR reduction than sCr.These markers are produced at a constant rate and filtered freely in the glomeruli,so their serum concentration can better reflect GFR.Based on the analysis of serum indices of 109 kids with renal transplantation who were followed up for more than one year,we explored the predictive value of Cys-C and beta-2-MG on DGF and renal function damage one year after renal transplantation,in order to provide evidence for clinical diagnosis of renal function damage,and to help for accurate evaluation of early renal function,timely clinical intervention and long-term maintenance of graft function.Section 1 Analysis of the risk factors of delayed graft function in pediatric renal transplantation from deceased donor ObjectiveTo explore the risk factors that influence delayed graft function of pediatric kidney transplantation from deceased donor.MethodThe clinical data of pediatric recipients who received renal transplantation from DD in the First Affiliated Hospital of Zhengzhou University from January 2012 to December 2018 were retrospectively analyzed.According to the occurrence of DGF after operation,the patients were divided into DGF group and non-DGF group.The clinical data of DGF group and non-DGF group were analyzed by univariate analysis,and the related risk factors affecting the recovery of allograft function were analyzed by multivariate analysis of variance logistic regression.ResultThe incidence rate of DGF was 11% in 163 children after renal transplantation,18 cases in DGF group and 145 cases in non-DGF group.Univariate analysis showed that the donor-recipient risk factors for DGF were female donors,donor age(>15 or < 1 years old),and donor terminal creatinine level(>100 μmol/L).Multivariate analysis also showed that donor age(> 15 or < 1 years old)and terminal creatinine level(> 100 μmol/L)were independent risk factors of DGF in children recipients.ConclusionThe age and the level of terminal creatinine of donors are independent risk factors of DGF in pediatric renal transplantation from DD.When evaluating the indicators of potential donors,these indicators should be taken as key evaluation items.Section 2 Predictive value of cystatin C and beta 2 micro-globulin in prognosis of pediatric renal transplantation from deceased donorObjectiveTo explore the role of serum cystatin C(Cys-C)and beta-2 micro-globulin(β2-MG)in predicting delayed graft function(DGF)and renal function impairment within 1 year after renal transplantation in children recipients.MethodA retrospective analysis of the children after renal transplantation from deceased donor in our center from January 2012 to December 2017 with one year follow-up.The levels of Cys-C,β2-MG,serum creatinine(s Cr)and urea nitrogen(BUN)were observed.The estimated glomerular filtration rate(e GFR)was calculated by Schwartz formula at the different time points after operation.Pearson correlation was used to analyze the correlation between various serum markers and e GFR.Receiver operating characteristics(ROC curve)was used to evaluate the role of various indicators in predicting DGF and renal function impairment one year after operation.Area under the curve(AUC)was used to evaluate the predictive effect of various indicators on the prognosis of transplanted kidney.ResultIn this group,8 cases suffered DGF in 109 children recipients of renal transplantation.Cys-C was superior to s Cr 、BUN and β2-MG in the diagnosis of DGF on the first day after operation(AUC :0.918 vs 0.855/0.881/0.808),the combined predictions of Cys-C and β2-MG had better diagnostic efficacy than single index(AUC: 0.922 vs 0.918/0.808).The correlation coefficients of s Cr,BUN,Cys-C,β2-MG and e GFR in 6 months and 12 months after operation were-0.518/-0.658,-0.505/-0.605,-0.457/-0.669,-0.476/-0.652,respectively.Six months after operation,s Cr,Cys-C and beta-2-MG were significant in predicting renal function impairment(AUC:0.744/0.755/0.759),and the combined predictions of Cys-C and beta-2-MG were better than the single predictors(AUC:0.802 vs 0.755/0.759)at six months after operation.ConclusionCys-C and beta-2-MG are of great value as predictors of early and stable stage after renal transplantation in children recipients,and have certain significance in predicting DGF and poor prognosis at one year after operation.SummaryThis study found that:1.The age and the level of terminal creatinine of donors are independent risk factors for the occurrence of DGF in pediatric renal transplantation from DD.When evaluating the indicators of potential donors,these indicators should be taken as key evaluation items.2.Cys-C and beta2-MG are of great value as predictors of early and stable stage after renal transplantation in children,and have certain significance in predicting the occurrence of DGF and poor prognosis at one year after operation.