| Objective:To analyze the risk factors of early graft dysfunction after renal transplantation; To present and evaluate the methods of diagnosis, prevention and treatment of it.Methods:One hundred and fifty-five cases of allograft renal transplantation performed between December 1999 and December 2002 in our center were analyzed retrospectively. The graft function of the major recipients (139 cases) had recovered to normal in three months after transplantation, but 10 recipients had lost their lives and 6 recipients had the invalid grafts removed in two months posttransplantation. According to their early allograft function, above-mentioned 139 cases were divided into two groups: early graft dysfunction (DGF/SGF n=79) and immediate graft function (IGF, n=60). At the 7th day post-operation, early allograft function was assessed clinically by urine output and serum creatinine (Scr). Patients who had a urine output >2000ml/24h and serum creatinine <140umol/L at the 7th day posttransplantation were classified as IGF. Patients who had a serum creatinine >140umol/L at the 7th day posttransplantation were classified as delayed graft function (DGF, n=28) if they needed dialysis or as slow graft function (SGF, n=51) if they did not. Using the unconditional logistic regression model, we studied the following related factors for DGF/SGF, ATN and AR: recipient gender, recipient age, primary disease, warm ischemia time, cold ischemia time, kidney harvesting time, kidney fitting time, anastomosis time, operation time, hypotension before allograft reperfusion during operation, Scr of recipients pretansplantation, donor/recipient ABO blood type, PRA, HLA-matching, retransplantation etc. The etiological diagnosis, differential diagnosis and treatment of DGF/SGF were analyzed.Results:Multivariate analysis revealed the following independent risk factors for DGF/SGF: male recipient(OR=4.325, 95%CI=1.548~11.587),hypotension before allograft reperfusion during operation(OR=8.124,95%CI=2.014~32.764),HLA mismatching (OR=2.602,95%CI=1.421~4.768), anastomosis time(OR=1.092,95%CI=1.032~1.155). A multivariate analysis of risk factors for ATN showed hypotension before allograft reperfusion during operation(OR=13.692, 95%CI=3.120~60.085)to be the most significantrisk factor. Recipient panel reactive antibodies of more than 10%(OR=6.762, 95%CI=2.551~17.920), HLA mismatching(OR=2.750, 95%CI=1.493~5.065)were independent risk factors for AR. The incidence of ATN was 71.4% in DGF group and it was the main cause of the DGF. The incidence of AR in DGF or SGF groups was significantly higher than that of IGF group (60.7%, 47.1% and 13.3%, respectively; p<0.01)。Using C2 (2-hr post-dose CsA levels) monitoring, the overall incidence of AR was lower compared with the C0 (trough CsA blood levels) group (11.4% vs. 30.3%,p<0.05). There were 4 cases of CsA-NT in C0 group, while none in C2 group. Besides ATN and AR, hemorrhagic complications (10 cases), CsA-NT (4 cases), infection (comprised 2 cases of pulmonary infection and 1 case of urinary tract infection), ureteric complications(comprised 2 cases of obstruction and 2 cases of ureteric necrosis presenting as urinary leakage) were observed in DGF/SGF patients and were also the causes of the DGF/SGF.The mean renal artery resistent index(RI)of allografts was significantly higher in the AR group compared with the ATN group (0.85±0.11 vs 0.76±0.07, P = 0.009). The RI was significantly higher in the ATN group compared with the non-ATN/AR group (0.76±0.07 vs 0.64±0.07, P< 0.001). Using RI≥0.80 to diagnose AR , the sensitivity, specificity and accuracy were77.5%, 90.2% and 84.0% respectively. We routinely carried out protocol biopsies in patients requiring dialysis 7 to 14 days posttransplant or unknown causes for Scr levels rising in 33 cases of recipients and revealed 8 cases of ATN/AR and 25 cases of AR (5 cases of slight AR). All recipients suffered from DGF were required 1 to 18 (6±4.48) post-operative haemodialysis (HD) treatments. 3 cases of DGF received CR...
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