医学
急性肾损伤
危险系数
肌酐
肾功能
肾脏疾病
比例危险模型
内科学
泌尿科
外科
置信区间
作者
Rémi Lenain,Camille Prouteau,Aghilès Hamroun,Yohann Foucher,Magali Giral,Mehdi Maanaoui,Marc Hazzan
标识
DOI:10.1053/j.ajkd.2021.06.022
摘要
Deceased donor acute kidney injury (AKI) frequently leads to kidney discards, but its impact on long-term graft survival in kidney transplant recipients remains unclear. We investigated the association between deceased donor AKI assessed using back-estimation of baseline serum creatinine (Scr) and graft survival.Observational cohort study.Adult patients represented within the French CRISTAL registry who received a single kidney allograft from brain-dead deceased donors between January 2006 and December 2017.A back-estimated Scr baseline value was derived for an assumed glomerular filtration rate at 75mL/min/1.73m2, using the MDRD Study equation. A refined classification system for donor AKI was implemented as follows: no AKI, undetermined AKI/chronic kidney disease (CKD), recovery from AKI, and ongoing AKI.Death-censored graft survival.Multivariable Cox models using a robust variance estimator for paired kidneys from the same donor.We classified 26,786 recipients as follows: no AKI (n=19,276); undetermined AKI/CKD (n=1,745); recovery from AKI (n=2,392); and ongoing AKI (n=3,373). We observed 4,458 kidney graft losses during a median follow-up period of 5.7 years. Compared with no AKI, ongoing AKI was associated with an increased risk of graft failure (hazard ratio [HR], 1.24 [95% CI, 1.13-1.35]). The HRs for graft failure in the undetermined AKI/CKD and recovery from AKI groups (1.22 [95% CI, 1.07-1.38] and 1.18 [95% CI, 1.06-1.31], respectively) were similar to those observed in the ongoing AKI group. The adverse effect of deceased donor AKI was no longer evident when relying either on the admission or the lowest Scr throughout the procurement procedure as baseline Scr.No measurement of urine output in donors.Deceased donor ongoing AKI, undetermined AKI/CKD, and recovery from AKI according to back-estimated baseline Scr are associated with decreased graft survival. The definition of baseline Scr as the first value measured on admission would have led to a misclassification bias and erroneous estimates.
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