背景:移植小受体大小的肾脏导致移植物功能较差。体表面积(BSA)与肾脏大小有关。我们使用BSA指数(BSAi)(供体BSA/受体BSA)来评估肾移植物的大小是否足以供受体使用。
方法:我们纳入了英国移植登记处的26,223例成人单肾移植(2007年01月31日-2019年12月31日)。我们将肾移植分为两组:BSAi≤0.75,0.751.25。我们比较了延迟的移植物功能率,其中主要无功能率和移植物存活率。(参考类别:BSAi≤0.75)。
结果:BSAi≤0.75的病例在活体肾移植中具有最高的移植功能延迟率(11.1%),(0.751.25=循环死亡后供体的肾脏移植在延迟移植物功能率方面没有显着差异(所有组中约40%)。在活体供体和脑死亡后供体的肾移植中,BSAi组的移植物存活率相似。来自BSAi≤0.75循环性死亡后的供体的肾移植具有最短的移植物存活率(0.751.25:HR=0.45,95%CI=0.31-0.66,p<0.001)。BSAi≤0.75的循环系统死亡后,供体的肾移植的十年移植物存活率为58.4%。
结论:BSAi≤0.75来自活体供者和脑死亡后供者的肾移植术后移植功能延迟风险较高。BSAi≤0.75的循环性死亡后,来自供体的肾移植的移植物存活率大大降低。
BACKGROUND: Transplanting kidneys small for recipient\'s size results in inferior graft function. Body surface area (BSA) is related to kidney size. We used the BSA index (BSAi) (Donor BSA/Recipient BSA) to assess whether the renal graft size is sufficient for the recipient.
METHODS: We included 26,223 adult single kidney transplants (01/01/2007-31/12/2019) from the UK Transplant Registry. We divided renal transplants into groups: BSAi ≤ 0.75, 0.75 < BSA ≤ 1, 1 < BSAi ≤ 1.25, BSAi > 1.25. We compared delayed graft function rates, primary non-function rates and graft survival among them. (Reference category: BSAi ≤ 0.75).
RESULTS: Cases with BSAi ≤ 0.75 had the highest delayed graft function rates in living-donor renal transplants (11.1%) (0.75 < BSAi ≤ 1: OR = 0.59, 95% CI = 0.32-1.1, p = 0.095, 1 < BSAi ≤ 1.25: OR = 0.46, 95% CI = 0.23-0.89, p = 0.022, BSAi > 1.25: OR = 0.32, 95% CI = 0.13-0.77, p = 0.011) and in renal transplants from donors after brain death (26.2%) (0.75 < BSAi ≤ 1: OR = 0.72, 95% CI = 0.55-0.96, p = 0.024, 1 < BSAi ≤ 1.25: OR = 0.62, 95% CI = 0.47-0.83, p = 0.001, BSAi > 1.25: OR = 0.65, 95% CI = 0.47-0.9, p = 0.01). There were no significant differences in renal transplants from donors after circulatory death regarding delayed graft function rates (~ 40% in all groups). Graft survival was similar among BSAi groups in renal transplants from living donors and donors after brain death. Renal transplants from donors after circulatory death with BSAi ≤ 0.75 had the shortest graft survival (0.75 < BSAi ≤ 1: HR = 0.55, 95% CI = 0.41-0.74, p < 0.001, 1 < BSAi ≤ 1.25: HR = 0.48, 95% CI = 0.35-0.66, p < 0.001, BSAi > 1.25: HR = 0.45, 95% CI = 0.31-0.66, p < 0.001). Ten-year graft survival rate was 58.4% for renal transplants from donors after circulatory death with BSAi ≤ 0.75.
CONCLUSIONS: Delayed graft function risk is higher in renal transplants with BSAi ≤ 0.75 coming from living donors and donors after brain death. Graft survival is greatly reduced in renal transplants from donors after circulatory death with BSAi ≤ 0.75.