Clinical analysis within one year after kidney transplantation from extended criteria donors of donation after citizen′s death

doi:10.3877/cma.j.issn.1674-3903.2019.02.008

Abstract

Abstract:

Objective

To compare the clinical efficacy within 1 year after kidney transplantation between extend criteria donors (ECD) and standard criteria donors (SCD) of donation after citizen′s death.

Methods

Clinical data of 90 recipients undergoing kidney transplantation from donation after citizen′s death in Xijing Hospital, Air Force Military Medical University during March 2014 and March 2017 were retrospectively analyzed. According to the types of donors, recipients were divided into the ECD group (n=31) and SCD group (n=59). All recipients were treated with immunoinduction therapy and triple immunosuppressive regimen (mycophenolate mofetil or mycophenolate sodium enteric-coated tablets + tacrolimus or cyclosporine + methylprednisolone). T test or Mann-Whitney U test were used to compare the serum creatinine (Scr) levels within 1 year after kidney transplantation between the two groups. The sex ratio, survival rate of recipients/transplant kidneys and incidence of acute rejection (AR), delayed graft function (DGF), pulmonary infection and other complications between the two groups were compared by χ² test and Fisher′s exact probability method. The difference was statistically significant when P<0.05.

Results

Scr levels of renal transplant recipients in ECD group and SCD group decreased gradually after transplantation. No statistical significance was observed in the levels of Scr within 1 months after transplantation (1, 3, 7, 14 and 21 days after transplantation) between the two groups (t=0.076, 0.905, 0.670, 0.893 and 0.048, P all>0.05). Except 9 months after transplantation, the levels of Scr within 1 year after kidney transplantation in ECD group was all higher than that in SCD group (P all<0.05). The 1 year survival rates of the recipients and transplant kidneys in two groups were 93.1%/80.6% and 91.5/84.7%, respectively, no statistical significance were observed (P=0.734; χ²=0.246, P>0.05). The incidence of AR, DGF, pulmonary infection and other complications in ECD group and SCD group were 12.9% (4/31) and 18.6% (11/59), 22.6% (7/31) and 22.0% (13/59), 25.8% (8/31) and 11.9% (7/59), 41.9% (13/31) and 28.8% (17/59), respectively, no significance was found (P all >0.05).

Conclusions

ECD kidney transplantation can achieve equivalent clinical efficacy compared with the SCD. The application of kidney grafts from ECD can enlarge the supply of donor kidneys under the current situation in which the donor organs was severely insufficient.

Key words: Donation after cardiac death, Extend criteria donor, Standard criteria donor, Kidney transplantation

Dongli Ruan, Geng Zhang, Kepu Liu, Zhibin Li, Huilong Wang, Long Gao, Wenfeng Zheng, Jianlin Yuan. Clinical analysis within one year after kidney transplantation from extended criteria donors of donation after citizen′s death[J]. Chinese Journal of Transplantation(Electronic Edition), 2019, 13(02): 118-122.

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References 15

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组别	例数	年龄(±s，岁)	性别(男/女，例)	透析时间(±s，月)	血清肌酐水平(±s，μmol/L)
ECD组	31	42±12	23/8	16±15	851±249
SCD组	59	39±10	50/9	23±19	873±260
t/χ²值	－	1.025	1.557	1.797	0.382
P值	－	>0.05	>0.05	>0.05	>0.05

组别	例数	年龄(±s，岁)	性别(男/女，例)	透析时间(±s，月)	血清肌酐水平(±s，μmol/L)
ECD组	31	42±12	23/8	16±15	851±249
SCD组	59	39±10	50/9	23±19	873±260
t/χ²值	－	1.025	1.557	1.797	0.382
P值	－	>0.05	>0.05	>0.05	>0.05

组别	例数	术后时间
组别	例数	1 d	3 d	7 d	14 d	21 d	1个月	2个月	3个月	4个月
ECD组	31	684±268	397±303	263±220	242±182	212±137	224±134	188±96	169±55	166±80
SCD组	59	689±302	343±249	303±279	286±233	211±134	168± 82	139±51	133±44	131±42
t值	－	0.076	0.905	0.670	0.893	0.048	2.382	3.091	3.060	2.456
P值	－	>0.05	>0.05	>0.05	>0.05	>0.05	<0.05	<0.05	<0.05	<0.05
组别	例数	术后时间(个月)
组别	例数	5	6	7	8	9	10	11	12
ECD组	31	161±85	178±103	154±106	166±151	136±72	142±68	141±84	161±60
SCD组	59	126±47	119± 50	95± 65	108± 66	106±70	106±59	79±75	125±39
t值	－	2.334	3.403	3.002	2.342	1.727	2.315	3.056	2.846
P值	－	<0.05	<0.05	<0.05	<0.05	>0.05	<0.05	<0.05	<0.05

组别	例数	术后时间
组别	例数	1 d	3 d	7 d	14 d	21 d	1个月	2个月	3个月	4个月
ECD组	31	684±268	397±303	263±220	242±182	212±137	224±134	188±96	169±55	166±80
SCD组	59	689±302	343±249	303±279	286±233	211±134	168± 82	139±51	133±44	131±42
t值	－	0.076	0.905	0.670	0.893	0.048	2.382	3.091	3.060	2.456
P值	－	>0.05	>0.05	>0.05	>0.05	>0.05	<0.05	<0.05	<0.05	<0.05
组别	例数	术后时间(个月)
组别	例数	5	6	7	8	9	10	11	12
ECD组	31	161±85	178±103	154±106	166±151	136±72	142±68	141±84	161±60
SCD组	59	126±47	119± 50	95± 65	108± 66	106±70	106±59	79±75	125±39
t值	－	2.334	3.403	3.002	2.342	1.727	2.315	3.056	2.846
P值	－	<0.05	<0.05	<0.05	<0.05	>0.05	<0.05	<0.05	<0.05

组别	例数	急性排斥反应	移植肾功能延迟恢复	肺部感染	其他
ECD组	31	4(12.9)	7(22.6)	8(25.8)	13(41.9)
SCD组	59	11(18.6)	13(22.0)	7(11.9)	17(28.8)
χ²值	－	－	0.0035	4.91	1.574
P值	－	0.486	>0.05	>0.05	>0.05

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