Multiple-factor Analysis And Donor Quality Scoring With Diagnostic Model In Deceased Donor Kidney Transplantation

ObjectivesThe aim was to investigate the factors that affect the early outcome of kidney transplantation between the donor after Cardiac and Brain death and then build a new donor quality scoring with a diagnostic model which could be specified to calculate the profile of a renal graft and provide an estimate of post-transplant outcome before transplantation.MethodsThis retrospective study included 625 patients who accepted first renal transplantation of Donor after Cardiac Death(DCD)and Brain Death(DBD)respectively at the Kidney Disease Center,First Affiliated Hospital,Medical College of Zhejiang University from Oct 1,2010 to Dec 31,2016.We collected the demographic profiles,and medical history information of the donors and recipients,and then compared the incidence of delayed graft function(DGF)and rejection with pathological diagnosis in the two different groups.Multiple-factor analysis was also used to investigate the factors that affected incidence of DGF.The estimated glomerular filtration(eGFR)of recipients at different time points within 1 year post-transplantation between recipients with great graft function and recipients with poor graft function were analysed and compared as well.Randomized table was used to randomly divided the patients into two groups of equation group(416)and verify group(209).The clinical data of patients in equation group were retrospectively analyzed through regression analysis using SPSS software to build a donor quality scoring model which checked by the verify group.ResultsCompared to the DBD donors,the age and the proportion of patients with cardio-pulmonary resuscitation(CPR)were higher in DCD donors.There is no significant difference of the incidence of DGF,rejection and graft function between DCD and DBD recipients.The results of the multiple-factor analysis showed that increasing terminal serum creatinine concentration of donor,one of the cause of death was cerebrovascular accident and high body surface area ratio(BSA)were independent risk factors for incidence of DGF in recipients transplanted from DCD and DBD.The estimated glomerular filtration(eGFR)of recipients with great graft function were better than the recipients with poor graft function at different time points within 1 year post-transplantation.A donor quality scoring with a diagnositic model,p= eY/(1+eY),Y=-1.632+0.037*X1(age of donor)-0.048*X2(weight of donor)+1.002*X3(history of hypertension)+0.909*X4(the cause of death was cerebrovascular accident)+0.004*X5(terminal serum creatinine concentration)was built.When the value of p was more than 0.11,the estimated 1-year graft function would be less than 45 ml/min/1.73m2,which could be used to estimate the early graft function before transplantation.The sensitivity and specificity of this diagnositic model were 72%and 72.3%,respectively.ConclusionThe incidences of DGF and graft function in 6-month and 1-year between DCD and DBD recipients were similar.The increasing terminal serum creatinine concentration of donor,the cause of death was cerebrovascular accident and high body surface area ratio(BSA)were independent risk factors for incidence of DGF.The diagnositic model could be used to estimate the early graft function before transplantation.