Analysis Of Related Factors Affecting The Recovery Of Transplanted Renal Function

Objective: To explore the factors affecting the clinical prognosis of transplant recipients.Methods: 263 kidney grafts were donated by 135 donors after cardiac death in First Hospital of Jilin University between Jan.2015 and Dec.2016.All of the kidneys underwent renal biopsy to assess the quality of the kidney.It was used as a standard for transplantation with GS less than 30% and no other serious pathological changes.The clinical data of the donor and recipient were recorded in detail,as well as the pathological changes of the histopathology in each case,including arteriolar hyalinosis(AH),interstitial fibrosis(IS),periglomerular fibrosis(PGF),glomerulosclerosis(GS),wall-to-lumen ratio(WLR).The serum creatinine status of the patients after the follow-up was followed up as a prognostic indicator.A multilevel mixed effect model was used to analyze the related factors that might influence the recovery of renal allograft function.Results: Under the premise that GS is less than 30%,no other serious pathological changes(AH,IS,PGF,GS,WLR)occur,the serum creatinine of the recipient at each time point after the transplantation was not statistically significant(P > 0.05).The donors' age,gender,BMI,cause of death,last serum creatinine level,and the recipients' age,dialysis mode and dialysis time had no significant effect on the recovery of the serum creatinine after the transplantation.With the recipients' age,BMI,dialysis mode,dialysis time changed,there was no statistical difference in the serum creatinine of the recipients at all time points after the transplantation(P>0.05).The recipients' BMI had an effect on the recovery of serum creatinine after the surgery.The serum creatinine were statistically different at each time point with different BMI recipients(regression coefficient 3.936,95% CI 0.584~7.288,P=0.021).Each time BMI was increased by 1 kg/?,the serum creatinine of corresponding time rised by 3.936 kg /?.Whether the donor CPR(cardiopulmonary resuscitation)had an effect on the recovery of recipients postoperative serum creatinine.Whether or not CPR,the serum creatinine of recipients at different time points is statistically different(regression coefficient-91.915,95%CI-140.459~-43.370,P < 0.001).The gender of the recipient affected the recovery of serum creatinine at all time points after the transplantation.Different gender of recipients in the postoperative serum creatinine values of each time point was statistically difference(regression coefficient of 38.254,95% CI 14.368 ~ 62.140,P=0.002).The male patients had relatively high serum creatinine levels at postoperative time points.Under the premise that GS is less than 30%,no other serious pathological changes(AH,IS,PGF,GS,WLR)occur,The pathological changes of donor kidney and its severity did not affect the occurrence of DGF after transplantation(P>0.05).The donors' age,gender,BMI,cause of death,and the recipients' age,gender,BMI,dialysis mode,dialysis time had no effect on the occurrence of DGF in recipients(P>0.05).Whether the donor CPR had an impact on the occurrence of the recipients' DGF(regression coefficient 0.873,OR=5.74,95% CI 1.64~20.09,P=0.006).The risk of DGF increased by 4.74 times after the donor had CPR.The donor's last serum creatinine had an effect on the occurrence of DGF of the recipients(regression coefficient-0.012,OR=0.99,95% CI 0.98~1,P=0.002).Conclusion:(1)In this study,under the premise that the GS of donor kidney is less than 30% and no other serious pathological changes occur,the pathological changes of the kidney(AH,IS,PGF,GS,WLR)and its severity had no effect on the recovery of renal function,and had no effect on the occurrence of postoperative DGF.(2)The CPR of donor affected the recipients' recovery of renal function after transplantation.The serum creatinine of recipient was higher at each point of time after the donor had CPR.The BMI of the recipient affected the recovery of renal function after transplantation.The recipients with smaller BMI had relatively lower serum creatinine levels at each time point after transplantation.(3)The donor CPR was a risk factor for the occurrence of postoperative DGF of the recipient.(4)The donor's last serum creatinine level influences the occurrence of DGF after transplantation.The higher the donor's last serum creatinine level,the higher the relative risk of donor's postoperative DGF.(5)the gender of the recipients had an impact on the recovery of serum creatinine after surgery,and the male patients had relatively high serum creatinine levels at all postoperative time points.