| OBJECTIVE:To explore the differences between standard donors for renal transplantation expansion and standard donors,and the factors influencing the recovery of organ function after renal transplant recipients,to improve the utilization rate of standard donors.Methods:A retrospective analysis of clinical data of 122 kidney transplant donors and their corresponding recipients from January 1,2015 to February 1,2019 in Urology,Baogang Hospital,Inner Mongolia.Donors were divided into two groups,the extended standard donor kidney group and the standard donor kidney group according to the Nyberg score.The two groups were compared first,and then DGF(Delayed Graft Function,delayed recovery of renal function)was performed after kidney transplant recipients.The incidence rate was dependent variable,and the donor-related clinical data were independent variables,and logistic regression analysis was performed;the creatinine level at 1 year after recipient kidney transplantation was used as the dependent variable,and donor-related clinical data were independent variables to determine its risk factors..After statistical software SPSS21.0,P<0.05 was statistically significantResults:1.The nyberg score(21.02±5.26)of the expanded standard donor group was significantly higher than that of the standard donor group(13.26 ± 4.68)(P=0.000);2 The age of the expanded standard donor group(50.89±13.16)was higher In the standard donor group(42.76 ± 9.88)years old(P=0.000);3.The proportions of hypertension(57.9%)and diabetes(7.3%)in the expanded donor group were significantly higher than those in the standard donor group(proportion)16.7%;0.00%)(P=0.000;P=0.012);4.The proportion of relative donors(10.5%)in the expanded donor group in donor sources was significantly lower than that in the standard donor group(33.3%)(P=0.001);5.The proportion of deaths due to cerebrovascular accidents in the expanded standard donor group(52.6%)was higher than that in the standard donor group(22.6%)(P=0.001);6.The corresponding recipients in the two groups Creatinine at various time points in the standard donor and recipient groups(345.97±47.03 ?mol/L on the 7th);(179.45±24.37 ?mol/L for 1 month);(145.73 ±24.18 ?mol/L for 3 months);(6 months 133.57±10.57 ?mol/L);(1 year creatinine 136.86± 17.45 ?mol/L)is significantly higher than the corresponding donor group of standard donors(206.58±22.85 ?mol/L respectively;137.31±9.71 ?mol/L L;116.25 ± 9.73 ?mol/L;107.86 ±9.85 ?mol/L;105.70 ± 10.15 ?mol/L)(P=0.001);7.Expand the standard donor-acceptor group to estimate the GFR(glomerular filtration rate,glomerular)on the 7th Filtration rate),1 month,3 months,6 months,and 1 year estimated GFR(51.66±6.63 ml/min*1.73m2;69.33±6.27 ml/min*1.73m2;70.49±6.93 ml/min*1.73 m2;77.06±4.54 ml/min*1.73m2;78.74±6.22 ml/min*1.73m2)levels are significantly lower than the standard donor recipient group(77.81 ± 7.90 ml/min*1.73m2 respectively;84.06±5.50ml/min*1.73m2;86.51±3.62ml/min*1.73m2;92.75±3.43 ml/min*1.73m2;94.05±3.47 ml/min*1.73m2),the differences are statistically significant(P=0.006,0.039,0.027,0.008,0.026).7.There was no significant difference in urine output between the two groups of donors at 7 days,1,3,6,and 12 months(P>0.05).8.Increasing the incidence of DGF in the standard donor recipient group(47.4%))Significantly higher than the standard donor counterpart recipient group(21.4%)(P=0.004);9.There was no significant difference in the number of HLA matching mismatches between the two groups of donors(expanding the standard donor group mismatch 4.05±1.01,standard donor group 3.57±1.33,P=0.051);10,the warm ischemia time(11.50±5.73min)of the expanded standard donor group was significantly longer than that of the standard donor group(8.89±6.26min)(P=0.031)).11.There was no significant difference in cold ischemia time between the two groups(619.86±326.62min for the expanded standard donor group and 597.96 ± 398.50min for the standard donor group)(P=0.767);12.BMI for the standard donor group was expanded(24.08±3.36)was not significantly different from the standard donor group(24.30±3.61)(P=0.757);13.In the donor donation,the low temperature mechanical perfusion group(25.9%)and the simple cold preservation group(36.5%)The difference in the incidence of DGF was not statistically significant(P=0.329).14.Multivariate Logistic regression analysis showed that the donor was older,had a longer period of cold ischemia,the donor had a lower estimated GFR,and was independent of the delayed recovery of renal function in kidney transplant recipients.Influencing factors(?=0.183,P=0.041;?=0.005,P=0.013;?=-0.020,P=0.015);15.Multivariate Logistic regression analysis showed that Nyberg score is an independent predictor of DGF(?=0.183,P=0.048).16.The overall human/renal survival rate was 96.7%/94.2%.Compared with the one-year human and renal survival rates in the two groups,there was no statistically significant difference in patient survival rate(P=0.408),and there was a statistical difference in the survival rate of the transplanted kidney(P=0.018<0.05).17.Multiple linear regression analysis was performed on the creatinine value of the 1-year recipient as the dependent variable:donor age,creatinine value before donor acquisition,and donor Nyberg score were risk factors for the recipient(?=1.292,P=0.022,respectively;?=0.316,P=0.023;?=2.655,P=0.002).Conclusions:1.There is a difference in renal function between the expanded standard donor and the standard donor after Nyberg scoring;the scoring system is helpful for predicting the effect of renal transplantation in patients.2.The age of the donor and the serum creatinine level before the acquisition have an effect on the incidence of DGF and the 1-year blood creatinine level in renal transplant recipients.3.The one-year survival rate of patients with expanded standard donors is not different from that of standard donors,and the survival rate of transplanted kidneys is relatively low.4.The changes of serum creatinine and eGFR in standard donors and standard donor recipients will become normal over time within a year.Enlarging the serum creatinine and eGFR of standard donor recipients is within the clinically acceptable range.Enlarging the standard donor can be one of the effective ways to increase the source of donors. |
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