Influência da função tardia do enxerto e do kidney donor profile index nos desfechos clínicos pós-transplante renal
Data
2023-04-30
Autores
Hazin, Maria Amélia Aguiar 
Tipo
Dissertação de mestrado
Título da Revista
ISSN da Revista
Título de Volume
Resumo
Introdução: O KDPI é um índice granular que se propõe a avaliar a qualidade do enxerto renal. A função tardia do enxerto (FTE) é uma das principais complicações do transplante renal com doador falecido no Brasil, estando associado à qualidade do órgão.
Objetivo: Avaliar a associação entre o KDPI e a FTE na função renal e sobrevida do enxerto em longo prazo, como parte da validação do KDPI no Brasil.
Métodos: estudo de coorte com 1.807 receptores de transplantes renais de doador falecido realizados entre 2013-15 e acompanhados até 2020. O desfecho primário foi FTE e os secundários foram FTE prolongada (≥14 dias), sobrevida do enxerto e taxa de filtração glomerular cinco anos após o transplante. A análise multivariada foi realizada por regressão logística, a sobrevida do enxerto por Kaplan-Meier e a análise de medidas repetidas por modelos mistos generalizados.
Resultados: a faixa de KDPI entre 51-85 foi predominante (43%), seguida por >85 (27%), 0-35 (19%) e 36-50 (11%). A incidência de FTE foi de 63%, variando de 51% no grupo com KDPI mais baixo para 68% no mais elevado (p<0,001). Tomando-se o KDPI 0-35 por referência, 51-85 (OR=1,97; p<0,001) e >85 (OR=2,25; p<0,001) associaram-se com FTE, mas 36-50 não (OR=1,38, p=0,08). Outras variáveis associadas à FTE foram: receptor (OR sim vs. não=1,23; p=0,04) e doador (OR sim vs. não=1,41, p=0,001) masculinos, tipo de diálise (OR para HD=2,06; p<0,001) e tempo em lista (OR para cada mês=1,005; p<0,001) e tempo de isquemia fria (TIF, OR para cada hora=1,03; p<0,001). Houve diferença no tempo em FTE de acordo com o KDPI (p=0,005), sendo mais evidente quando >85 (vs. 35-50, p=0,015; vs. 50-85, p=0,003). FTE prolongada foi observada em 11,2% dos pacientes, estando associada ao KDPI>85 (OR vs. 0-35=2,52; p=0,003), além de tempo em lista (OR para cada mês=1,006; p<0,001) e TIF (OR para cada hora=1,04; p=0,008). As outras faixas de KDPI não se associaram com FTE prolongada. A FTE prolongada impactou a sobrevida do enxerto em 5 anos (p<0,001), mas a presença de FTE per se não (p=0,71). Observou-se uma redução inversa e significativa entre e TFG entre 1-5 anos e as faixas de KDPI (p<0,001), por outro lado, FTE (vs. não, p<0,001) e TIF mais elevados (< ou ≥22hs, p<0,001) só interferiram na TFG 1-5 anos em KDPI 0-35.
Conclusões: Houve associação entre o KDPI e FTE, entretanto apenas KDPI> 85 associou-se à FTE prolongada. O KDPI impactou na função renal de longo prazo, mas FTE e TIF só interferiram na
função renal de receptores de KDPI baixos. A FTE prolongada associou-se a menor sobrevida do enxerto em longo prazo.
Introduction: The KPDI is a granular index proposed to evaluate the quality of kidney grafts. Delayed graft function (DGF) is one of the leading deceased-donor kidney transplant complications in Brazil and is associated with graft quality. Objective: To evaluate the association between KDPI and DGF on kidney transplant outcomes and long-term graft survival and function as part of efforts to validate the KDPI in Brazil. Methods: This historical single-center cohort study enrolled 1,807 kidney transplant recipients who received a graft from a deceased donor between 2013 and 2015 and followed up until 2020. The primary outcome was DGF, and the secondary outcomes were prolonged DGF (≥14 days), graft survival, and glomerular filtration rate (GFR) five years after transplantation. The multivariate analyses were performed using logistic regression models, graft survival was analyzed with Kaplan- Meier, and mixed generalized models estimated graft function over time. Results: KDPI between 51-85% was the most common group (43%), followed by >85% (27%), 0- 35% (19%) and 36-50% (11%). The DGF incidence was 63%, varying between 51% in the lowest KDPI group to 68% in the highest KDPI group (p<0.001). Using KDPI 0-35% as reference, 51-85% (OR=1.97; p<0.001) and >85% (OR=2.25; p<0.001) were associated with DGF, but 36-50% was not (OR=1.38; p=0.08). Other variables associated with DGF were: male receptor (OR yes vs. no=1.23; p=0.04) and donor (OR yes vs. no=1.41; p=0.001), dialysis method (OR for hemodialysis= 2.06; p<0.001), waiting time for transplantation (OR for each month=1.005; p<0.001) and cold ischemia time (CIT, OR for each hour=1.03; p<0.001). There was a difference on time in DGF according to KDPI (p=0.005), that was pronounced when > 85% (vs. 35-50, p=0,015; vs. 51-85%, p=0.003). Prolonged DGF was observed in 11,2% patients and was associated with KDPI>85% (OR vs. 0- 35%=2.52; p=0.003), waiting time for transplantation (OR for each month=1.006; p<0.001) and CIT (OR for each hour=1.04; p=0.008). Other KDPI groups were not associated with prolonged DGF. Prolonged DGF impact on graft survival five years after transplantation (p<0.001), but DGF per se not (p=0.71). A significant negative association was observed between GFR in 1-5 years and KDPI xvi groups (p<0.001). However, DGF (vs. not, p<0.001) and higher CIT (< or ≥ 22 hours, p<0.001) only influence GFR 1-5 years when KDPI was 0-35%. Conclusions: KDPI was associated with DGF, but only KDPI> 85% was associated with prolonged DGF. KDPI impacts long-term graft function, but DGF and CIT only impact graft function on lower KDPI. Prolonged DGF was associated with lower long-term graft survival.
Introduction: The KPDI is a granular index proposed to evaluate the quality of kidney grafts. Delayed graft function (DGF) is one of the leading deceased-donor kidney transplant complications in Brazil and is associated with graft quality. Objective: To evaluate the association between KDPI and DGF on kidney transplant outcomes and long-term graft survival and function as part of efforts to validate the KDPI in Brazil. Methods: This historical single-center cohort study enrolled 1,807 kidney transplant recipients who received a graft from a deceased donor between 2013 and 2015 and followed up until 2020. The primary outcome was DGF, and the secondary outcomes were prolonged DGF (≥14 days), graft survival, and glomerular filtration rate (GFR) five years after transplantation. The multivariate analyses were performed using logistic regression models, graft survival was analyzed with Kaplan- Meier, and mixed generalized models estimated graft function over time. Results: KDPI between 51-85% was the most common group (43%), followed by >85% (27%), 0- 35% (19%) and 36-50% (11%). The DGF incidence was 63%, varying between 51% in the lowest KDPI group to 68% in the highest KDPI group (p<0.001). Using KDPI 0-35% as reference, 51-85% (OR=1.97; p<0.001) and >85% (OR=2.25; p<0.001) were associated with DGF, but 36-50% was not (OR=1.38; p=0.08). Other variables associated with DGF were: male receptor (OR yes vs. no=1.23; p=0.04) and donor (OR yes vs. no=1.41; p=0.001), dialysis method (OR for hemodialysis= 2.06; p<0.001), waiting time for transplantation (OR for each month=1.005; p<0.001) and cold ischemia time (CIT, OR for each hour=1.03; p<0.001). There was a difference on time in DGF according to KDPI (p=0.005), that was pronounced when > 85% (vs. 35-50, p=0,015; vs. 51-85%, p=0.003). Prolonged DGF was observed in 11,2% patients and was associated with KDPI>85% (OR vs. 0- 35%=2.52; p=0.003), waiting time for transplantation (OR for each month=1.006; p<0.001) and CIT (OR for each hour=1.04; p=0.008). Other KDPI groups were not associated with prolonged DGF. Prolonged DGF impact on graft survival five years after transplantation (p<0.001), but DGF per se not (p=0.71). A significant negative association was observed between GFR in 1-5 years and KDPI xvi groups (p<0.001). However, DGF (vs. not, p<0.001) and higher CIT (< or ≥ 22 hours, p<0.001) only influence GFR 1-5 years when KDPI was 0-35%. Conclusions: KDPI was associated with DGF, but only KDPI> 85% was associated with prolonged DGF. KDPI impacts long-term graft function, but DGF and CIT only impact graft function on lower KDPI. Prolonged DGF was associated with lower long-term graft survival.