| Objective:To explore a reasonable method for evaluating the warm ischemia in renal transplantation with the follow-up of renal transplantation recipients with cardiac death donors(DCD).Method:A retrospective analysis was performed on 367 recipients receiving DCD renal transplantation from May 2011 to June 2015 in the nephrology center of the First Affiliated Hospital of Zhejiang University.According to the occurrence of postoperative delayed graft function(DGF),the recipients are divided into DGF group and non-DGF group.According to renal function after 1 month and 1 year follow-up(whether the eGFR is greater than or equal to 60 ml/min/1.73m),the recipients are divided into higher renal function group and lower renal function group.The changes and differences of blood oxygen and systolic blood pressure are compared between different groups,so are the fundamental state.Logistic regression analysis of the influencing factors of DGF and multivariate analysis of influencing factors of renal function 1 year after the transplantation are made in this research.Results:The creatinine of the donors in DGF group was higher than that in non-DGF group(129.04±84.07 vs 92.22±73.70?mol/L,p=0.002),the eGFR of the donors in DGF group was significantly lower than that in non-DGF group(80.58±41.40 vs 107.87±43.80 ml/min/1.73m2,p<0.001).The body surface area of DGF group was significantly higher than that of non-DGF group(1.74±0.18 vs 1.70±0.17 m2,p=0.042).The body surface area ratio of DGF group was significantly lower than that of non-DGF group(1.74±0.18 vs 1.70±0.17 m2,p=0.042).No significant differences were found between DGF group and non-DGF group in terms of the thermal ischemia assessment at different time points after removal of life support devices.Logistic regression analysis showed that the ratio of eGFR and D/R BSA was an independent predictor of DGF after DCD renal transplantation.1 month postoperatively:The eGFR of the donors,D/R BSA of the higher renal function group(eGFR>= 60 ml/min/1.73m)were significantly higher than that of the lower renal function group(eGFR of the donors:112.43±42.59 vs 88.71±43.74 ml/min/1.73m2,p<0.001;D/R BSA:1.04±0.17 vs 1.00±0.19,p=0.011).The age of the donors,the age of the recipients,the creatinine of the donors,the BMI of the recipients,the BSA of the recipients,the Glomerular pathology score,the incidence rate of DGF were significantly lower than that of the lower renal function group(age of the donors:33.50±13.54 vs 38.28±15.20,p=0.002;age of the recipients:39.87±10.97 vs 42.46±11.31,p=0.031;creatinine of the donors:89.55±80.66 vs 112.58±68.55?mol/L,p=0.005;BMI of the recipients:20.63±2.72 vs 21.79±3.54 kg/m2,p=0.001,BSA of the recipients;1.68±0.17 vs 1.73±0.18 m2,p=0.005;glomerular pathology score:0.30±0.59 vs 0.48±0.71,p=0.032;incidence rate of DGF:11/211(5.21%)vs 50/91(54.95%),p<0.001).The time from the removal of life support device to the disappearance of the blood oxygen in the higher renal function group was significantly longer than that in the lower renal function group(7.99±5.29 vs 6.66±4.35 min,p=0.016).The time of initial blood oxygen in the higher renal function group decreased to 90%,80%,70%,and 60%was significantly higher than that in the lower renal function group.It was also found that the descent rate in the higher renal function group was significantly slower than that in the lower renal function group from the initial blood oxygen decreasing to 90%,70%and 60%after the removal of life support device.However,in the higher renal function group,the time from the donor blood oxygen saturation was lower than 70%to the start of perfusion was significantly shorter than that of the lower renal function group(15.33±4.39 vs 17.08±6.24 min,p=0.026).1 year postoperatively:The eGFR and male percentage of the donors in the higher renal function group were significantly higher than that in the lower renal function group(eGFR of the donors:110.02±45.20 vs 86.73±38.28 ml/min/1.73m2,p<0.001,the male percentage:86.49%vs 74.07%,p=0.009).The age of donors and recipients,BMI of donors,glomerular pathological score and renal tubular pathological score in the higher renal function group were significantly lower than that in the lower renal function group(age of the donors:32.62±13.80 vs 43.53±12.34,p<0.001;age of the recipients:40.00±10.98 vs 43.88±10.74,p=0.006;BMI of the donors:21.77±2.83 vs 22.49±2.52 kg/m2,p=0.04;glomerular pathological score:0.30±0.59 vs 0.48±0.71,p=0.011;renal tubular pathological score:0.37±0.64 vs 0.43±0.52,p=0.006).The time from the removal of life support device to the disappearance of the blood oxygen in the higher renal function group was significantly longer than that in the lower renal function group(8.00±5.19 vs 6.10±4.35 min,p=0.006).In the higher renal function group,the time from the blood oxygen saturation was 90%,80%,70%and 60%to the disappearance of the oxygen saturation was significantly longer than that in the lower renal function group.In the higher renal function group,the descent rate of the blood oxygen was significantly slower than that in the lower renal function group from the removal of life support device to the disappearance of the blood oxygen(19.60±17.49 vs 25.80±22.85%/min,p=0.038).Multivariate linear regression analysis showed:age of the donors,age of the recipients,BSA of the recipients were negatively correlated with the eGFR in 1 year postoperatively;Male donors,the time that the oxygen saturation exists were positively correlated with the eGFR in 1 year postoperatively.Conclusions:The prognosis of DCD renal transplantation is influenced by the ages of the donors and recipients,gender and renal function of the donors,and the results of renal biosy of the donors certain implications for long-term prognosis.In the warm ischemia assessment,maybe it is more accurate to divide the warm ischemia into two periods:high oxygen period(withdrawal of life support device-oxygen saturation 70%)and low oxygen period(oxygen saturation below 70%-perfusion).In the period of high blood oxygen,a longer period of existence of blood oxygen and a slower descent rate of blood oxygen may have a protective effect on the prognosis,prolonged hypoxia may lead to organ damage.Defined the warm ischemia as time from the donor oxygen less than 70%to perfusion can evaluate the prognosis of renal function 1 months after operation better.Considering the shortage of organs,it will be the key to the development of kidney transplantation that exploring the safety critical of each factor and extending the donor range under the condition of ensuring the quality of patients'life after operation. |
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