- MeSH
- aktivace komplementu * fyziologie imunologie účinky léků MeSH
- atypický hemolyticko-uremický syndrom etiologie farmakoterapie prevence a kontrola MeSH
- inaktivátory komplementu terapeutické užití MeSH
- lidé MeSH
- monoklonální protilátky farmakologie terapeutické užití MeSH
- opožděný nástup funkce štěpu farmakoterapie prevence a kontrola MeSH
- rejekce štěpu * imunologie prevence a kontrola MeSH
- transplantace ledvin * škodlivé účinky MeSH
- trombotické mikroangiopatie etiologie imunologie prevence a kontrola MeSH
- Check Tag
- lidé MeSH
BACKGROUND: Organ shortage leads to the increased use of expanded-criteria donor (ECD) kidneys, which contribute to a higher risk of delayed graft function (DGF) after transplantation. The aim of this study was to determine factors that may better predict the risk of DGF. METHODS: Histologic assessments of donor renal biopsy were used with other clinical variables to predict the risk of DGF after kidney transplantation. The total Banff score equaled the sum of interstitial fibrosis (CI), tubular atrophy, arteriolar hyaline thickening, fibrous intimal thickening (CV), and fraction of sclerotized glomeruli. RESULTS: In total, 126 of 344 patients developed DGF after kidney transplantation. The histologic score for CI, tubular atrophy, and CV and the total Banff score were increased in patients with DGF. Only CI and CV were independent predictors of DGF (P<0.01). A CIV score (CI+CV; odds ratio, 2.68; 95% confidence interval, 1.55-4.66; P<0.001) was superior to the combination of the total Banff score (odds ratio, 1.48; 95% confidence interval, 0.85-2.55; P=NS). A CIV score≥1, donor age more than 51 years, and anoxia donor brain injury were associated with the highest risk of DGF. A CIV<1 identified a subgroup of ECDs at a lower risk of DGF comparable with standard-criteria donors (29.3% vs. 28.4%). CONCLUSIONS: Composite CIV score better identifies ECD kidneys with a lower risk of developing DGF. Morphologic evaluation of ECD kidneys and donor characteristics may improve kidney allocation.
- MeSH
- biopsie MeSH
- dárci tkání zásobování a distribuce MeSH
- dospělí MeSH
- fibróza MeSH
- hodnocení rizik MeSH
- ledviny patologie chirurgie MeSH
- lidé středního věku MeSH
- lidé MeSH
- lineární modely MeSH
- logistické modely MeSH
- mladiství MeSH
- mladý dospělý MeSH
- multivariační analýza MeSH
- nefrektomie * MeSH
- odds ratio MeSH
- opožděný nástup funkce štěpu etiologie prevence a kontrola MeSH
- prediktivní hodnota testů MeSH
- retrospektivní studie MeSH
- rizikové faktory MeSH
- senioři MeSH
- transplantace ledvin škodlivé účinky metody MeSH
- výběr dárců metody MeSH
- výsledek terapie MeSH
- Check Tag
- dospělí MeSH
- lidé středního věku MeSH
- lidé MeSH
- mladiství MeSH
- mladý dospělý MeSH
- mužské pohlaví MeSH
- senioři MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- práce podpořená grantem MeSH
- srovnávací studie MeSH
Static cold storage is generally used to preserve kidney allografts from deceased donors. Hypothermic machine perfusion may improve outcomes after transplantation, but few sufficiently powered prospective studies have addressed this possibility. METHODS: In this international randomized, controlled trial, we randomly assigned one kidney from 336 consecutive deceased donors to machine perfusion and the other to cold storage. All 672 recipients were followed for 1 year. The primary end point was delayed graft function (requiring dialysis in the first week after transplantation). Secondary end points were the duration of delayed graft function, delayed graft function defined by the rate of the decrease in the serum creatinine level, primary nonfunction, the serum creatinine level and clearance, acute rejection, toxicity of the calcineurin inhibitor, the length of hospital stay, and allograft and patient survival. RESULTS: Machine perfusion significantly reduced the risk of delayed graft function. Delayed graft function developed in 70 patients in the machine-perfusion group versus 89 in the cold-storage group (adjusted odds ratio, 0.57; P=0.01). Machine perfusion also significantly improved the rate of the decrease in the serum creatinine level and reduced the duration of delayed graft function. Machine perfusion was associated with lower serum creatinine levels during the first 2 weeks after transplantation and a reduced risk of graft failure (hazard ratio, 0.52; P=0.03). One-year allograft survival was superior in the machine-perfusion group (94% vs. 90%, P=0.04). No significant differences were observed for the other secondary end points. No serious adverse events were directly attributable to machine perfusion. CONCLUSIONS: Hypothermic machine perfusion was associated with a reduced risk of delayed graft function and improved graft survival in the first year after transplantation. (Current Controlled Trials number, ISRCTN83876362.) 2009 Massachusetts Medical Society
- MeSH
- analýza přežití MeSH
- délka pobytu MeSH
- dospělí MeSH
- kreatinin krev MeSH
- lidé středního věku MeSH
- lidé MeSH
- mladiství MeSH
- mladý dospělý MeSH
- mrtvola MeSH
- multivariační analýza MeSH
- nízká teplota MeSH
- opožděný nástup funkce štěpu krev prevence a kontrola MeSH
- perfuze MeSH
- proporcionální rizikové modely MeSH
- rejekce štěpu MeSH
- senioři nad 80 let MeSH
- senioři MeSH
- transplantace ledvin MeSH
- uchovávání orgánů MeSH
- Check Tag
- dospělí MeSH
- lidé středního věku MeSH
- lidé MeSH
- mladiství MeSH
- mladý dospělý MeSH
- senioři nad 80 let MeSH
- senioři MeSH
- MeSH
- akutní poškození ledvin etiologie prevence a kontrola terapie MeSH
- Buddův-Chiariho syndrom etiologie prevence a kontrola terapie MeSH
- chirurgie trávicího traktu metody využití MeSH
- cholangitida komplikace prevence a kontrola terapie MeSH
- infekce farmakoterapie komplikace mikrobiologie MeSH
- krvácení komplikace prevence a kontrola MeSH
- lidé MeSH
- nemoci jater chirurgie patologie MeSH
- opožděný nástup funkce štěpu etiologie prevence a kontrola terapie MeSH
- pooperační komplikace diagnóza etiologie prevence a kontrola MeSH
- přežívání štěpu účinky léků účinky záření MeSH
- transplantace jater metody patologie využití MeSH
- výsledky a postupy - zhodnocení (zdravotní péče) využití MeSH
- Check Tag
- lidé MeSH
