我们分析了已故供体肾移植(KT)受者的肾脏供体指数(KDPI)与冷缺血时间(CIT)之间是否存在相互作用。在2014年至2020年期间在美国接受KT的成年人被纳入,并分为三个KDPI组(<20%,21-85%,>85%)和fourCIT层(<12、12-17.9、18-23.9,≥24小时)。多变量分析用于测试以下结果的KDPI和CIT之间的相互作用:原发性移植物非功能(PGNF),延迟移植物功能(DGF),估计6个月和12个月时的肾小球滤过率,患者生存,移植物存活,和死亡审查的移植物存活。总共分析了69,490名接受者:18,241名(26.3%)接受了KDPI<20%的移植物,46,953(67.6%),KDPI21-85%,和4,296(6.2%),KDPI>85%。我们证实,KDPI和CIT的增加与KT后结局更差有关。与我们的假设相反,KDPI和CIT之间的相互作用仅对PGNF和DGF有统计学意义。此外,交互作用的负系数表明,相对于高KPDI移植物,CIT持续时间的增加对低KDPI和中等KDPI器官更有害。相反,对于死亡率,移植物存活,和死亡审查的移植物存活,我们发现CIT和KDPI之间的相互作用没有统计学意义。我们得出结论,虽然,KDPI高和CIT延长是KT后不良结局的独立危险因素,它们的相互作用仅对KT后的短期结局有意义,对低KDPI和中等KDPI移植物的影响更明显。意义陈述:肾供体资料指数(KDPI)和冷缺血时间(CIT)都是移植后结果的独立预测因子。然而,关于这两个因素之间相互作用的文献非常有限。在这项研究中,我们分析了美国国家数据,证实较低的KDPI值和较短的CIT与移植后的短期和长期结局最佳相关.然而,即使对于具有longCIT(>24小时)的高KDPI肾脏(>85%)的接受者,移植后的结果是可以接受的,与我们的假设相反,我们没有发现证据表明KDPI和CIT对患者或移植物存活率有显著的交互作用.因此,我们得出结论,尽管CIT应该总是最小化,即使选择了具有延长CIT的高KDPI肾脏,也有可能获得足够的移植后结果。
We analyzed whether there is an interaction between the Kidney Donor Profile Index (KDPI) and cold ischemia time (CIT) in recipients of deceased donor kidney transplant (KTs). Adults who underwent KTs in the United States between 2014 and 2020 were included and divided into 3 KDPI groups (≤20%, 21%-85%, >85%) and 4 CIT strata (<12, 12-17.9, 18-23.9, ≥24 hours). Multivariate analyses were used to test the interaction between KDPI and CIT for the following outcomes: primary graft nonfunction (PGNF), delayed graft function (DGF), estimated glomerular filtration rate (eGFR) at 6 and 12 months, patient survival, graft survival, and death-censored graft survival (DCGS). A total of 69,490 recipients were analyzed: 18,241 (26.3%) received a graft with KDPI ≤20%, 46,953 (67.6%) with KDPI 21%-85%, and 4,296 (6.2%) with KDPI >85%. Increasing KDPI and CIT were associated with worse post-KT outcomes. Contrary to our hypothesis, howerver, the interaction between KDPI and CIT was statistically significant only for PGNF and DGF and eGFR at 6 months. Paradoxically, the negative coefficient of the interaction suggested that increasing duration of CIT was more detrimental for low and intermediate-KDPI organs relative to high-KDPI grafts. Conversely, for mortality, graft survival, and DCGS, we found that the interaction between CIT and KDPI was not statistically significant. We conclude that, high KDPI and prolonged CIT are independent risk factors for inferior outcomes after KT. Their interaction, however, is statistically significant only for the short-term outcomes and more pronounced on low and intermediate-KDPI grafts than high-KDPI kidneys.