Kev Txiav Txim Ntawm Qhov Ntsuas Thiab Qhov Ncauj Ntawm Glomerular Filtration Rate nyob rau hauv cov neeg tau txais kev pab ntawm Lub raum Hloov Hloov

Hu rau:joanna.jia@wecistanche.com/ WhatsApp: 008618081934791

Martina Hamböck, thiab al

Cov ntsiab lus

Keeb kwm ntawm tus neeg mob lub raum kev ua haujlwm yog suav tias yog qhov tseem ceeb ntawm kev muaj sia nyob ntawm allograft tom qab kev hloov pauv raum (LD) raum, tab sis nws txoj kev ywj pheej cuam tshuam rau kev hloov pauv ntawm kev ua haujlwm graft tsis tshua txhais tau zoo. Lub hom phiaj ntawm txoj kev tshawb no yog txhawm rau txheeb xyuas qhov txheeb ze ntawm LD lub raum ua haujlwm rau lub hauv paus kwv yees glomerular filtration rate (eGFR) ntawm cov neeg tau txais kev pab thiab nws qhov poob qis.

Txoj hauv kev hauv txoj kev tshawb no 91 LD lub raum hloov pauv tau ua thaum xyoo 2007 thiab 2015 suav nrog. TheeGFR ntawm lub raum pub dawb (eGFR-DK) tau suav los ntawm tag nrho LD eGFR (eGFR-dt) raws li cov txiaj ntsig ntawm isotope nephrography. Tus neeg tau txais eGFR (eGFR-r) tau txiav txim siab 6-ib hlis txog 36 lub hlis tom qab hloov pauv tau txais txiaj ntsig raws li qhov sib txawv ntawm cov qauv sib xyaw ua qauv kwv yees cov kev hloov pauv hauv lub hauv paus allograft function (intercept) thiab eGFR-r txoj kab nqes. Cov qauv raug hloov kho rau eGFR-DK lossis eGFR-dt, ntxiv rau, rau lwm tus neeg muaj peev xwm confounders.

Xaus Cov yam ntxwv ntsig txog tus neeg pub dawb, feem ntau yog qhov ua haujlwm ntawm lub raum pub dawb thiab LD hnub nyoog, tau kwv yees ntawm eGFR ntawm qhov pib. ABMR tau raug txheeb xyuas tias yog lub hauv paus tseem ceeb ntawm kev ua haujlwm tsis zoo ntawm allograft.

Ntsiab lus:Antibody-mediated rejection · Donorage · Kwv yees glomerular filtration rate · Isotopenephrography· Hloov raum

cistanche deserticola cov txiaj ntsigrau lub raum

Taw qhia

Kev hloov pauv hauv lub raum (LD) yog suav tias yog qhov kev kho mob zoo tshaj plaws rau cov neeg mob uas muaj kab mob raum kawg (ESRD), tso cai rau cov txiaj ntsig zoo ntawm cov neeg mob muaj sia nyob, kev ua neej zoo, thiab cov nuj nqis ntsig txog kev noj qab haus huv. Ua tib zoo xaiv LD, txawm li cas los xij, yog qhov tseem ceeb los xyuas kom meej qhov kev kho mob tau zoo tshaj plaws thiab kev nyab xeeb siab tshaj plaws rau ob tus neeg pub dawb thiab cov neeg tau txais kev pab.

Txhawm rau pab txhawb kev ua haujlwm ntawm lub peev xwmraumCov neeg pub dawb, ntau lub teb chaws thiab thoob ntiaj teb cov lus qhia tau tsim, feem ntau ntawm lawv pom zoo tias glomerular filtration rate (GFR) yuav tsum tau soj ntsuam nrog kev ntsuas ncaj qha ntawm exogenous filtration markers, ntxiv rau cov ntshav creatinine-raws li kev kwv yees ntawm GFR [1, 2] . Qib ntawmraummuaj nuj nqiaccepted for donation need to be adapted to the individual risk profile, but for individuals with a GFR of >90mL / min rau 1.73 m2, feem ntau suav hais tias muaj kev nyab xeeb pub dawb. Tsis tas li ntawd, isotope nephrography (ING) tuaj yeem pab txiav txim siab qhov txheeb ze ntawm lub raum txhawb kev xaiv ntawm nephrectomy sab [1, 2].

Nyob rau hauv xyoo tas los no, tau muaj ib qho kev hloov pauv rau kev lees txais ntawm qhov tseem ceeb LD comorbidities, tshwj xeeb tshaj yog nyob rau hauv cov neeg laus, muab qhov kev pheej hmoo ntawm kev loj hlob ntawm lub neej.mob ntevraumkab mobqis [3]. Qhov no kuj tseem suav nrog cov neeg pub dawb nrog GFR hauv qab qhov kev lees paub feem ntau [4]. Kev siv marginal pub raum, txawm li cas los xij, tuaj yeem cuam tshuam loj heev rau kev ua haujlwm ntawm allograft. Ib qho kev pheej hmoo tseem ceeb hauv qhov kev hwm no tau pom tias yog LD hnub nyoog. Cov kev tshawb fawb loj hauv pawg tau nthuav tawm cov txiaj ntsig tsis zoo rau lub sijhawm luv thiab ntev rau cov kabmob uas tshwm sim los ntawm cov laus pub dawb [5–10]. Cov txiaj ntsig tau zoo ib yam nrog cov kev soj ntsuam tau ua hauv kev hloov pauv raum tuag (DD) raum, qhov chaw faib khoom nruab nrog yog txhawb nqa los ntawm cov hnub nyoog sib piv algorithms, uas coj cov kev xav tau ntawm cov neeg tau txais txiaj ntsig mus rau hauv tus account [11].

Cov txiaj ntsig txheeb ze ntawm kev pub dawb ua ntejraummuaj nuj nqinyob rau hauv LD transplantation tsis tau kawm zoo. Norden et al. [12] tau pom tias muaj kev pheej hmoo ntau ntxiv rau kev poob qis hauv cov pej xeem ntawm 344 LD raum hloov pauv cov neeg tau txais txiaj ntsig thaum cov neeg pub dawb muaj qhov tsis hloov kho GFR qis dua 80mL / min. Qhov kev tshawb pom no tau txais kev txhawb nqa los ntawm kev tshuaj xyuas zoo ntawm xya qhov kev tshawb fawb, qhia txog cov koom haum ntawm cov neeg pub nyiaj siab dua GFR nrog kev ua haujlwm zoo tshaj plaws thiab kev hloov pauv txoj sia [13]. Cov ntsiab lus ntawm GFR, txawm li cas los xij, yog qhov sib txawv, tsis muaj kev hloov kho rau cov neeg tsis sib haum xeeb, thiab muaj peev xwm cuam tshuam ntawm kev ua haujlwm tsis sib luag ntawm cov khoom pub dawb thiab cov raum ntxiv tsis raug suav nrog. Tsis tas li ntawd, tsis muaj ib qho ntawm cov kev tshawb fawb no suav nrog kev soj ntsuam ntxaws ntxaws ntawm txoj kab nqes ntawm tus neeg tau txais kev kwv yees glomerular filtration rate (eGFR), uas, ua rau muaj kev ntxhov siab los ntawm ntau yam kev tiv thaiv kab mob thiab tsis muaj kab mob, yuav ua rau muaj txiaj ntsig zoo rau qhov kawg ntawm kev kwv yees ntev lub raum allograft ciaj sia [ 14, 15] ib.

Hauv qhov kev tshawb fawb rov qab no, qhov cuam tshuam ywj pheej ntawm LDraum muaj nuj nqintawm tus neeg tau txais eGFR ntawm lub hauv paus (kev cuam tshuam) thiab nws txoj kab nqes nqes los ntawm kev ntsuas eGFR tau tshawb xyuas thaum thawj 3 xyoo tom qab hloov pauv. Txhawm rau ntxiv qhov tseeb rau kev tshuaj ntsuam eGFR ntawm lub raum pub dawb tau muab cais los ntawm cov txiaj ntsig ntawm Tc-99m-mercaptoacetyltriglycine acid (99mTc-MAG3) scintigraphy. Cov qauv sib xyaw ua ke tau siv los ntsuas qhov cuam tshuam ntawm LD lub raum kev ua haujlwm ntawm kev ua haujlwm ntawm allograft, nyob rau hauv cov ntsiab lus ntawm lwm yam muaj feem cuam tshuam txog qhov sib txawv.

Cov ntaub ntawv thiab cov txheej txheem

Kawm tsim thiab cov neeg mob

Lub hom phiaj tseem ceeb ntawm qhov kev tshawb fawb ib leeg-center cohort no yog txhawm rau txheeb xyuas qhov kev koom tes ntawm LD lub raum kev ua haujlwm, raws li tau pom los ntawm (i) eGFR ntawm lub raum pub dawb (eGFR-DK) lossis (ii) tag nrho cov neeg pub dawb eGFR (eGFR-nws) , mus rau hauv paus allograft muaj nuj nqi ntawm 6 lub hlis (intercept) thiab nws cov chav kawm kom txog rau thaum 36 lub hlis tom qab transplantation (txoj kab nqes). Txoj kev tshawb no suav nrog 91 ntawm 258 LD allograft cov neeg tau txais kev pabcuam ntawm Vienna hloov pauv chav tsev thaum lub Ib Hlis 2007 thiab Lub Kaum Ob Hlis 2015. Cov txheej txheem suav nrog yog cov neeg tau txais hnub nyoog siab dua lossis sib npaug li 18 xyoo, muaj ING-raws li kev faib ua haujlwm ntawm lub raum pub dawb, thiab ua tiav kev soj ntsuam kom txog rau thaum lub Plaub Hlis 2018, suav nrog kev ntsuas tus neeg tau txais eGFR (eGFR-r) ntawm kev tawm hauv tsev kho mob thiab ntawm 6, 12, 18, 24 thiab 36 lub hlis tom qab hloov pauv. Ntawm cov neeg tau txais kev pab, 167 tsis ua raws li cov qauv no thiab tsis suav nrog kev tshuaj xyuas. Daim ntawv qhia kev khiav dej num yog muab rau hauv daim duab 1. Txoj kev tshawb fawb tau pom zoo los ntawm Pawg Neeg Saib Xyuas Kev Ncaj Ncees (No. 2252/2017) thiab tau ua raws li cov hauv paus ntsiab lus ntawm Kev Tshaj Tawm ntawm Helsinki 2008 thiab Tshaj Tawm ntawm Istanbul.

Kev ntsuas lub raum ua haujlwm

Kwv yees GFR tau suav nrog kev sib koom ua ke ntawm Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) [16]. Txog thaum Lub Ob Hlis 2012, 24-h cov zis creatinine tshem tawm tau raug soj ntsuam rau kev xaiv LD. Tom qab ntawd, cov neeg ua haujlwm pub dawb suav nrog kev ntsuas ntsuas GFR (mGFR) siv chromium -51 ethylenediaminetetraacetic acid (51Cr-EDTA). Cov neeg pub dawb tau txais kwv yees li 2 MBq ntawm cov cim qhia pom radiolabelled thiab tau txais cov ntshav coj mus kuaj (120, 180, thiab 240min tom qab kev tswj hwm) tau ua haujlwm los txiav txim siab txog kev tshem tawm cov ntshav. Lub cev saum npoo thaj tsam-kho GFR qhov tseem ceeb tau suav nrog hauv software hauv tsev, raws li tau piav qhia los ntawm Geist li al. [17]. Raws li peb cov qauv hauv zos, creatinine tshem tawm lossis hloov kho mGFR qis dua 80mL / min raug suav tias yog ib qho kev txwv tsis pub pub nephrectomy.

Isotope nephrography

Renal 99mTc-MAG3 scintigraphy to determine the relative functional distribution between the two donor kidneys (split kidney function) was performed according to the protocol of the European Association of Nuclear Medicine [18]. Image acquisition was performed with a gamma camera, as previously described [19]. The imaging software HERMES GoldTM (Hermes Medical Solutions AB, Stockholm, Sweden) was used to draw regions of interest (ROIs) around the kidneys, the heart, and the perirenal background. The mean transit time (MTT) and the relative kidney function from 1min to 3min were extracted from the integrals of renal time-activity curves (TACs). The LD candidates with a side difference of >20% (>60 feem pua ​​vs.<40%) were="" not="" accepted="" for="" donation.="" the="" relative="" function="" determined="" by="" renal="" mag3="" scintigraphy="" was="" used="" to="" calculate="" egfr-dk="" and="" the="" mgfr="" of="" the="" donated="" kidney="" (mgfr-dk)="" by="" its="" multiplication="" with="" egfr-dt="" or="" total="" ld="" mgfr="" (mgfr-dt),="" respectively.="" the="" egfr="" of="" the="" remaining="" kidney="" (egfr-rk)="" was="" calculated="" by="" subtraction="" of="" egfr-dk="" from="" egfr-dt.="" mtt="" values="" of="" 1.9–2.9min="" were="" considered="" normal="">

Kev tiv thaiv kab mob

Feem ntau ntawm cov neeg tau txais kev pab (89 feem pua) tau txais calcineurin inhibitor-raws li kev tiv thaiv kev tiv thaiv kab mob, feem ntau yog triple therapy nrog rau tacrolimus, mycophenolic acid, thiab steroids (Table 1). Feem ntau cov neeg tau txais (90 feem pua) kuj tau txais interleukin (IL) - 2 receptor antibody induction. Thaum kho cov tshuaj tiv thaiv kab mob tau hloov pauv hauv 14 ntawm cov neeg mob (tacrolimus rau cyclosporin A: n= 4; tacrolimus rau sirolimus lossis everolimus: n= 4; belatacept rau tacrolimus: n= 3; sirolimus los yog everolimus rau tacrolimus: n= 2; cyclosporin A rau tacrolimus: n= 1). Qhov nruab nrab tacrolimus trough theem yog 7.7 ng / mL thiab 6.3 ng / mL tom qab 6 thiab 12 lub hlis, feem. Ntawm cov neeg mob, yim tau hloov pauv thoob plaws ABO cov teeb meem loj, tom qab chav kawm ntawm ABO antigen-specific (n= 6) lossis semi-selective (nyob rau hauv cov xwm txheej ntawm cov tshuaj tiv thaiv ntxiv-HLA pub dawb tshwj xeeb, DSA: n{ {23}}) immunoadsorption thiab ib koob tshuaj rituximab thiab intravenous immunoglobulin (IVIG).

Hloov biopsies

Kev kuaj biopsies tau ua rau kev ua haujlwm tsis zoo thiab / lossis cov proteinuria tseem ceeb. Peb tus qauv tsis suav nrog kev soj ntsuam biopsies. Histomorphology thiab immunohistochemistry tau soj ntsuam ntawm formalin-taw paraffin-embedded seem. T cell-mediated rejection (TCMR) thiab antibody-mediated rejection (ABMR) tau txhais raws li 2015 hloov tshiab ntawm Banff kev faib tawm ntawm lub raum allograft pathology [21].

Kev txheeb cais

Cov ntaub ntawv tsis tu ncua tau hais tawm raws li qhov nruab nrab thiab qhov sib txawv (IQR) thiab categorical variables raws li qhov tseeb thiab txheeb ze zaus. Kev tshuaj xyuas Kaplan-Meier tau siv rau kev suav ntawm kev cog qoob loo thiab cov neeg mob muaj sia nyob. Kev cuam tshuam ntawm LD lub raum ua haujlwm ntawm lub hauv paus eGFR-r thiab ntawm nws txoj kab nqes tau soj ntsuam siv cov qauv sib xyaw ua ke. Peb suav ob tus qauv sib cais, uas LD lub raum ua haujlwm yog tus cwj pwm los ntawm eGFR-dk lossis los ntawm eGFR-dt, thiab LD lub raum ua haujlwm thiab lub sijhawm suav nrog hauv txhua qhov kev suav. Slope kwv yees ntxiv suav nrog kev sib cuam tshuam ntawm kev hloov pauv nrog lub sijhawm. Hauv cov qauv txo qis, ob peb lwm tus neeg pub dawb thiab tus neeg txais kev hloov pauv tau ntxiv ib qho los ntawm ib qho. Tus qauv multivariable tau nthuav dav los ntawm qhov sib txawv nrog P-tus nqi ntawm<0.157 for="" their="" impact="" on="" baseline="" egfr-r="" or="" its="" slope="" in="" the="" reduced="" model="" [22].="" levels="" of="" egfr-r="" from="" 6="" months="" to="" 36="" months="" were="" used="" as="" dependent="" variables.="" for="" correlation="" analysis,="" spearman's="" rank="" correlation="" test="" was="" applied.="" a="" 2-="" sided="">< 0.05="" was="" considered="" significant.="" for="" statistical="" analysis,="" ibm="" spss="" statistics="" 23="" for="" mac="" (ibm="" corporation,="" armonk,="" ny,="" usa)="" and="" sas="" 9.4="" for="" windows="" (the="" sas="" institute="" inc.,="" cary,="" nc,="" usa)="" were="">

cistanche hauv Hindi

Cov txiaj ntsig

Cov yam ntxwv ntawm tus neeg mob

Txoj kev tshawb no suav nrog 91 tus neeg laus tau txais LD raum allograft. Cov ntsiab lus tseem ceeb suav nrog yog cov ncauj lus kom ntxaws ING-raws li LD ua haujlwm thiab ua tiav cov neeg tau txais kev pom zoo.

Cov ntaub ntawv tseem ceeb ntawm tus neeg pub dawb thiab tus neeg txais tau muab nyob rau hauv Cov Lus 1 thiab 2, raws li. Lub hnub nyoog nruab nrab ntawm cov neeg tau txais kev pab yog 42 xyoo thiab 35 feem pua ​​​​ntawm cov neeg mob yog poj niam. Feem ntau ua rau ESRD yog glomerulonephritis thiab polycystic raum kab mob, 31 feem pua ​​​​ntawm cov neeg mob tau txais kev hloov pauv ua ntej thiab 11 feem pua ​​​​yog cov neeg tau txais kev hloov pauv. Qhov nruab nrab ntawm HLA tsis sib haum hauv A, B, thiab DR yog peb (Table 1).

LD yog nyob rau nruab nrab hnub nyoog 52 xyoos, thiab 63 feem pua ​​​​yog poj niam thiab 53 feem pua ​​​​ntawm cov neeg pub nyiaj tau nyob nrog. Kev ntsuam xyuas ntawm LD lub raum ua haujlwm tau nthuav tawm qhov nruab nrab eGFR-dt ntawm 87mL / min / 1.73 m2 thiab qhov nruab nrab mGFR-dt ntawm 120mL / min / 1.73 m2, ntsig txog. Lub cev ua haujlwm ntawm 51 feem pua ​​​​rau cov raum pub dawb, ntawm 80.2 feem pua ​​​​yog cov raum sab laug. Qhov nruab nrab eGFR-dk thiab mGFR-dk yog 43 thiab 62mL / min / 1.73 m2, raws li (Table 2).

Allograft thiab cov neeg tau txais txiaj ntsig

Cov txiaj ntsig ntawm kev hloov pauv tau piav qhia hauv Table 3. Cov chav kawm ntawm eGFR-r mus txog 36 lub hlis tom qab hloov pauv tau piav qhia hauv daim duab 2. Nyob rau hauv tag nrho cov pawg, qhov tsis muaj kev kho qhov nruab nrab eGFR-r ntawm 6 lub hlis (intercept) yog 56.5mL/min/1.73 m2 (95 feem pua ​​​​CI: 52.3–60.7mL/min/ 1.73 m2), thiab qhov tsis kho qhov nruab nrab txhua xyoo poob ntawm allograft muaj nuj nqi (txoj kab nqes) yog -0.2 (–1.8–1.3) mL/min/1.73m2 .

Qib ntawm eGFR-r ntawm kev tso tawm hauv tsev kho mob cuam tshuam nrog kev pub dawb ua ntej LD eGFR (Fig. 3). Kev sib raug zoo tau muaj zog dua yog tias tus neeg mob lub raum ua haujlwm tau pom los ntawm eGFR-dk dua li eGFR-dt (rho=0.32 piv rau rho=0.23). Ntxiv mus, muaj kev sib raug zoo ntawm kev pub dawb ua ntej LD eGFR, qhia raws li eGFR dt lossis eGFR ntawm lub raum tshuav (eGFR-RK), thiab tom qab pub dawb LD eGFR (rho=0.65) (Fig. 3 ).

Feem ntau cov histopathological fifindings nyob rau hauv qhov qhia txog biopsies yog TCMR (n{0}}) thiab ABMR (n= 10). Ua raws li Banff 2015 scheme, 3 tus neeg tau txais kev kuaj mob ABMR, thiab 7 tus neeg tau txais nrog ABMR (Table 3).

Lub xyoo 1-xyoo, 3-xyoo, thiab 5-xyoo tuag-censored graft ciaj sia taus yog 100 feem pua, 98 feem pua, thiab 95 feem pua, raws li (Fig. 2). Ntawm cov neeg mob, 9 poob lawv cov kev hloov pauv tom qab lub sijhawm nruab nrab ntawm 5.7 xyoo, feem ntau (6 tus neeg mob) los ntawm ABMR (BK tus kab mob nephropathy: n= 1; tsis paub ua rau: n= 2). Cov neeg mob muaj sia nyob ntawm 1,3 thiab 5 xyoos yog 100 feem pua, 98 feem pua, thiab 98 feem pua, raws li (Table 3). Zuag qhia tag nrho, peb qhov kev tuag tau sau tseg thaum rov qab los (ob leeg nrog kev ua haujlwm allograft).

Cov txiaj ntsig ntawm tus neeg pub lub raum ua haujlwm ntawm tus neeg tau txais eGFR

Peb tau siv ob qho qauv sib xyaw ua ke los ua tus yam ntxwv ntawm LD raum ua haujlwm ntawm eGFR-r. Thawj tus qauv (Table 4) tau hloov kho rau eGFR-dk thiab lwm yam muaj feem cuam tshuam rau cov neeg pub dawb- lossis tus neeg tau txais kev hloov pauv. Kev txheeb xyuas ntau qhov sib txawv tau qhia txog qhov cuam tshuam tseem ceeb ntawm eGFR-dk ntawm eGFR-r ntawm lub hauv paus (0.6mL/min/1.73 m2, 95 feem pua ​​CI: 0.1–1.1mL/min/1.73 m2 txhais tau tias kwv yees nce ib chav tsev; P= 0.02) tab sis tsis nyob ntawm eGFR-r nqes hav (P= 0.27). ABMR yog qhov kev kwv yees muaj zog tshaj plaws ntawm eGFR-r txoj kab nqes (txhais tau tias qhov kev poob qis txhua xyoo: -5.8 (–10.4 txog -1.2) mL/min/1.73 m2; P= 0.01). Peb kuj tau pom qhov cuam tshuam tsis zoo ntawm tus neeg pub lub cev qhov ntsuas (BMI; P= 0.04). Lwm qhov hloov pauv tau xaiv rau kev tshuaj xyuas ntau yam, suav nrog LD hnub nyoog, tus neeg pub dawb thiab tus neeg tau txais kev pab, kev tiv thaiv kab mob hauv qab, lossis MTT, txawm li cas los xij, tsis muaj txiaj ntsig zoo. Qhov tseem ceeb, kuj tseem hloov pauv ua ntej tsis cuam tshuam nrog kev ua haujlwm ntawm allograft.

Tus qauv thib ob (Table 5) suav nrog tib qhov sib txawv tab sis tau hloov kho rau eGFR-dt. Tsis muaj qhov cuam tshuam tseem ceeb ntawm eGFR-dt ntawm eGFR-r ntawm lub hauv paus (P= 0.14) lossis nws txoj kab nqes (P= 0.52). Hauv cov qauv no, txawm li cas los xij, kev nce LD hnub nyoog tau pom tias muaj kev sib koom ua ke nrog qis hauv qab eGFR-r (–0.5 (–1 txog 0)) mL/min/1.73m2mean kwv yees qis ib xyoos twg; P=0 05). Raws li nyob rau hauv thawj tus qauv, qhov tshwm sim ABMR muaj kev cuam tshuam rau txoj kab nqes eGFR-r (txhais tau tias qhov kev poob qis txhua xyoo: -5.7 (–10.4 txog -1.0) mL/min/1.73 m2; P= 0.02). Hauv cov qauv no, tsuas yog pom muaj qhov tshwm sim me ntsis rau BMI (P= 0.05).

Kev sib tham

Lub hom phiaj tseem ceeb ntawm txoj kev tshawb fawb no yog txhawm rau txheeb xyuas qhov cuam tshuam ntawm LD lub raum kev ua haujlwm ntawm tus neeg tau txais txiaj ntsig eGFR (intercept) ntawm 6 lub hlis thiab eGFR nqes hav. Cov txiaj ntsig tseem ceeb ntawm kev txheeb xyuas ntau qhov sib txawv yog tias eGFR ntawm lub raum pub dawb, thiab ntxiv rau LD hnub nyoog, muaj kev ywj pheej ntawm kev ua haujlwm ntawm allograft ntawm lub hauv paus, thaum tsis muaj txiaj ntsig zoo ntawm eGFR nqes hav. Raws li cov kev tshawb fawb yav dhau los [23–25], ABMR yog qhov tseem ceeb ntawm kev hloov pauv kev ua haujlwm tsis zoo, nrog rau qhov cuam tshuam txhais tau tias eGFR nqes hav ntawm kwv yees li -6mL / min / 1.73 m2 toj xyoo piv rau–0.2mL/ min / 1.73 m2 toj ib xyoo nyob rau hauv tag nrho pawg.

LD raum hloov pauv yog qhov kev xaiv kho mob zoo tshaj plaws rau cov neeg mob ESRD, tso cai rau cov txiaj ntsig kho mob tau zoo, nrog 1- thiab 5- xyoo graft ciaj sia taus ntawm 96 feem pua ​​​​thiab 87 feem pua, raws li qhia rau Tebchaws Europe [26] . Txawm li cas los xij, vim muaj kev hloov pauv loj heev, txawm li cas los xij, qhov kev thov rau cov neeg pub khoom nruab nrog cev tau nce ntxiv. Nyob rau hauv xyoo tas los no, muaj kev nce qib ntawm kev siv cov laus LD, uas feem ntau tuaj nrog cov kev pheej hmoo ntxiv, xws li rog rog, kub siab lossis qis GFR qib (txawm tias qis dua 60mL / min / 1.73 m2) [4]. Ib qho piv txwv rau kev siv cov nyiaj pub dawb ua rau muaj kev txhawj xeeb txog kev nyab xeeb loj txog cov txiaj ntsig LD mus ntev. Tsis tas li ntawd, cov kev hloov pauv no, feem ntau yog LD hnub nyoog thiab lub raum ua haujlwm, kuj tseem yog ib qho tseem ceeb ntawm kev sib raug zoo ntawm tus neeg txais kev pabcuam allograft. Cov kev tshawb fawb yav dhau los tau pom tias cov neeg tau txais lub raum los ntawm cov neeg pub nyiaj laus yog qhov muaj feem pheej hmoo ntawm kev ncua sij hawm graft, graft tsis ua haujlwm, thiab tuag [5, 6]. Cov koom haum zoo sib xws tau raug pom zoo rau cov nyiaj pub dawb ua ntej GFR, tab sis hauv cov neeg tau txais kev pab me me thiab hauv cov kev tshawb fawb tsis zoo tsim [13].

Rau peb txoj kev tshawb fawb, peb tau xaiv lub hauv paus eGFR-r ntawm 6 lub hlis thiab eGFR-r nqes hav xam los ntawm 6- kev ntsuas txhua hli raws li qhov sib txawv ntawm cov qauv sib xyaw. Muaj ntau cov pov thawj tias qhov kev poob qis ntawm eGFR lub sij hawm tuaj yeem ua qhov txiaj ntsig zoo rau qhov kawg rau lub raum ciaj sia nyob ntev, hauv kev hloov pauv [14, 15] thiab kab mob hauv lub raum [27, 28]. Piv txwv li, kev soj ntsuam ib pawg sib law liag ntawm 508 cov neeg tsis hnov ​​​​tsw DD lossis LD lub raum allograft tau txais, Wiebe li al. [23] tau piav qhia txog kev sib raug zoo ntawm eGFR thiab kev muaj sia nyob mus ntev. Kev tsom mus rau ib pab pawg neeg tshwj xeeb ntawm cov neeg tau txais lub raum allograft uas tsim cov tshuaj tiv thaiv kab mob novo pub dawb (dnDSA), qhov tseem ceeb 6 feem pua ​​​​nce hauv kev pheej hmoo ntawm post-dnDSA graft poob raug xam rau txhua 1mL / min / 1.73m2 decease hauv eGFR ntawm 3 xyoos tom qab subclinical dnDSA pib [23].

Peb tau txheeb xyuas cov neeg pub rau lub raum ua haujlwm thiab, raws li cov kev tshawb fawb yav dhau los [9, 10], cov hnub nyoog pub dawb raws li tus kws tshaj lij ywj pheej ntawm lub hauv paus ntawm eGFR-r, txhawb nqa qhov muaj txiaj ntsig ntawm cov kev txwv no rau kev pheej hmoo stratification ntawm lub cev los ntawm cov neeg muaj peev xwm raum. Hauv peb pawg ntawm LD raum hloov pauv, eGFR-dk tau cuam tshuam nrog qhov kev kwv yees nce ntxiv hauv cov neeg tau txais txiaj ntsig eGFR ntawm 0.6mL / min / 1.73 m2 ib chav tsev, thiab cov hnub nyoog pub dawb nce ntxiv tau cuam tshuam nrog kev txo qis hauv cov neeg tau txais txiaj ntsig eGFR. Hauv qhov sib piv, peb pom tsis muaj qhov cuam tshuam loj rau tag nrho lub raum ua haujlwm hauv eGFR dt-kho tus qauv. Qhov txiaj ntsig no qhia tau tias muaj txiaj ntsig zoo rau kev kuaj mob ntawm ING rau kev ntsuam xyuas ntawm kev ua haujlwm sab nraud hauv cov ntsiab lus ntawm LD kev ntsuas; Txawm li cas los xij, peb paub txog qhov tsawg tus qauv me me uas yuav tau txwv tsis pub kuaj pom qhov sib txawv me ntsis. Rau lwm qhov ING-raws li qhov ntsuas-MTT kom ntsuas qhov kev hloov pauv ntawm parenchymal tracer transit-peb pom tsis muaj kev koom tes nrog ib qho ntawm cov ntsiab lus kawg, qhia tias qhov kev ntsuas no yuav muaj qhov ntsuas tus nqi tsawg hauv kev ntsuas ntawm lub raum ua haujlwm ib txwm muaj; Txawm li cas los xij, kev hloov hauv lub raum tsis zoo tuaj yeem pab txhawm rau txheeb xyuas qee yam kab mob, xws li mob tubular raug mob lossis cyclosporine toxicity hauv lub raum hloov [29].

cov txiaj ntsig cistanche

Interestingly, thaum muaj qhov cuam tshuam rau BMI, peb txoj kev tshawb fawb tsis tau qhia txog qhov cuam tshuam tseem ceeb ntawm LD lub raum ua haujlwm (thiab hnub nyoog) ntawm txoj kab nqes ntawm eGFR-r. Qhov kev tshawb pom no tau npaj txhij txog kev xav txog qhov muaj peev xwm ua haujlwm ntawm lub raum tsis ua haujlwm tshwj xeeb cuam tshuam nrog qis tus neeg pub GFR, uas tuaj yeem ua rau raug mob vim hyperfiltration hauv cov nephrons ntxiv [30]; Txawm li cas los xij, peb xav taw qhia tias peb tus qauv hauv zos tsis lees txais cov neeg pub dawb nrog kev ntsuas GFR (los yog tso zis creatinine tshem tawm)<80ml in="" and/or="" unequal="" distribution="" of="" kidney="" function="" detected="" by="" ing="" (="">20 feem pua ​​​​ntawm qhov sib txawv), thiab txoj cai no tau ua rau tag nrho kev suav nrog cov raum pub dawb nrog cov txiaj ntsig zoo hauv lub hauv paus (qhov nruab nrab eGFR-dk: 43 (IQR: 38–50) mL / min / 1.73m2; nruab nrab txheeb ze ua haujlwm: 51 (48– 54) feem pua). Peb cov txiaj ntsig tau ua raws li kev txheeb xyuas ua ntej ntawm 4488 tus neeg mob, feem ntau yog cov neeg tau txais DD, qhov twg lub hnub nyoog pub dawb muaj kev cuam tshuam loj rau tus neeg tau txais eGFR ntawm 12 lub hlis, tab sis tsis muaj kev cuam tshuam rau eGFR nqes hav [9]. Tej zaum vim yog qhov sib txawv ntawm qhov sib txawv hauv cov ntaub ntawv xaiv, uas kuj tseem suav nrog qhov sib txawv ntawm cov yam ntxwv pub dawb, lwm cov kev tshawb fawb tau qhia txog qhov tsis sib haum xeeb. Piv txwv li, hauv kev tshawb fawb los ntawm Issa et al. [8] Kev hloov pauv hauv eGFR ntawm LD cov neeg tau txais lub raum nyob rau lub sijhawm 2 xyoos tom qab hloov pauv tau kwv yees ntawm -8.76mL / min / 1.73 m2, yog tias cov neeg pub dawb muaj hnub nyoog ntau dua lossis sib npaug rau 45 xyoo thiab ntawm -7.40mL / min / 1.73 m2, yog tias cov neeg pub dawb muaj qhov tsis hloov pauv ua ntej pub dawb eGFR ntawm<110ml in.="" moreover,="" also="" in="" two="" other="" larger="" studies="" [7,="" 10],="" donor="" age="" was="" reported="" to="" be="" a="" significant="" determinant="" of="" progressive="" functional="" deterioration="" of="" renal="" allografts,="" in="" one="" of="" these="" studies="" [10],="" however,="" only="" beyond="" the="" first="" post-transplantation="">

Ib qho kev tshawb pom loj ntawm peb txoj kev tshawb fawb yog tias ABMR (10 tus neeg tau txais kev pab hauv peb pawg neeg) tau dhau los ua qhov muaj zog tshaj plaws ntawm eGFR-r poob txhua xyoo. Kev kuaj mob ntawm tus mob hnyav lossis mob ntev ABMR, qhov ua rau kev ua txhaum ntawm kev ua tsis tiav hauv peb pawg (rau ntawm cuaj qhov kev poob tag nrho), tau pom tias muaj feem cuam tshuam nrog qhov txhais tau tias eGFR-r nqes hav ntawm kwv yees li -6mL / min / 1.73 m2 toj xyoo. . Qhov kev soj ntsuam no yog ua raws li cov ntaub ntawv yav dhau los txhawb kev cuam tshuam ntawm ABMR ntawm lub raum allograft cov txiaj ntsig [31]. Ob peb txoj kev tshawb fawb tau txheeb xyuas qhov kev tshawb pom ntawm dnDSA lossis kev kuaj mob ntawm ABMR nyob rau hauv kev sib raug zoo ntawm eGFR poob. Piv txwv li, Wiebe et al. [23] pom eGFR poob ntawm -3.15 thiab -5.61mL/min/1.73m2 toj xyoo hauv cov neeg mob uas muaj subclinical (n{16}}) thiab chaw kho mob (n= 45) dnDSA, feem. Ntxiv mus, nyob rau hauv ib tug tsis ntev los no randomized tswj mus soj ntsuam ntsuam xyuas bortezomib nyob rau hauv 44 cov kev kawm nrog lig ABMR, eGFR slopes yog hais txog -5mL / min / 1.73m2 ib xyoo nyob rau hauv ob qho tib si placebo thiab kev kho mob pawg [24]. Cov txiaj ntsig zoo sib xws (eGFR nqes hav ntawm kwv yees li -7mL / min / 1.73m2 ib xyoos ib xyoos ntawm 25 cov kev kawm randomized) tau tshaj tawm hauv kev sim ntsuas cov txiaj ntsig ntawm kev sib xyaw IVIG thiab rituximab hauv ABMR nrog kev hloov pauv glomerulopathy [25]. Cov chav kawm tsis zoo ntawm allograft muaj nuj nqi hauv cov neeg mob nrog ABMR, tsis zoo li TCMR, tuaj yeem cuam tshuam txog qhov tsis muaj peev xwm kho tau zoo tam sim no los tiv thaiv hom kev tsis lees paub, tshwj xeeb tshaj yog lig ABMR cuam tshuam nrog kev raug mob irreversible [24, 25]. Peb cov ntaub ntawv txhawb nqa qhov xav tau ntawm kev tsim cov kev ntsuas zoo los tiv thaiv lossis kho ABMR

Peb txoj kev tshawb fawb muaj ntau yam kev txwv. Ib qho kev txwv loj yog qhov piv txwv me me, uas yog vim qhov kev tshawb fawb monocentric tsim thiab txwv tsis pub muaj ING cov ntaub ntawv hauv peb pawg. Thaum peb muaj peev xwm txheeb xyuas qhov muaj zog ywj siab kwv yees ntawm kev ua haujlwm ntawm kev hloov pauv hloov pauv, peb txoj kev tshawb fawb yuav muaj

tsis tau muaj peev xwm txaus los txheeb xyuas qhov cuam tshuam tsis zoo ntawm qee qhov kev hloov pauv uas muaj feem cuam tshuam, xws li kev tiv thaiv kab mob hauv qab (xws li calcineurin inhibitors piv rau belatacept, uas yuav ncua kev ua haujlwm tsis zoo [32]). Lwm qhov kev txwv yog qhov nruab nrab-lub sij hawm ua raws li (nruab nrab 7 xyoo), uas nyob rau hauv peb pawg ntawm LD raum hloov cov neeg tau txais coincided nrog ib tug tsawg tus nqi ntawm graft poob (10 feem pua). Yog li, raws li cov kev tshawb fawb yav dhau los, peb tau xaiv eGFR txoj kab nqes los ua qhov kawg ntawm tus neeg sawv cev, uas tso cai rau peb txhawm rau txheeb xyuas cov txiaj ntsig sib txawv txawm nyob hauv (i) pawg me me thiab (ii) tom qab lub sijhawm luv luv. Thaum kawg, nws kuj tseem yuav raug suav hais tias yog ib qho kev txwv uas peb qhov kev tshuaj xyuas yog raws li kev kwv yees ntawm cov ntshav creatinine ntawm tus neeg mob lub raum. Ntsuas GFR tsuas yog muaj rau ib nrab ntawm cov LD suav nrog thiab qhov ua piv txwv qhov loj me yuav muaj tsawg dhau los txhawm rau txheeb xyuas cov txiaj ntsig muaj txiaj ntsig. Rau peb txoj kev tshawb fawb, peb tau xaiv qhov sib npaug CKD-EPI, uas, sib piv rau lwm qhov sib npaug, xws li MDRD kab zauv, yuav muaj tseeb dua qhov GFR hauv cov ntsiab lus uas lub raum ua haujlwm [16].

Thaum peb cov txiaj ntsig tau txhawb nqa tias LD lub raum ua haujlwm thiab hnub nyoog ntawm nws tus kheej kwv yees kev ua haujlwm ntawm lub hauv paus, peb tsis muaj peev xwm ua kom pom qhov cuam tshuam tseem ceeb ntawm cov kev hloov pauv no ntawm txoj kab nqes ntawm cov neeg txais GFR. Hauv qhov sib piv, qhov tshwm sim ntawm ABMR tau dhau los ua qhov muaj kev pheej hmoo loj tshaj plaws rau kev ua kom poob ntawm allograft muaj nuj nqi tom qab LD raum hloov pauv.

Kev lees paub

Cov kws sau ntawv xav ua tsaug rau ElisabethLehner rau nws qhov kev txhawb nqa tseem ceeb hauv kev sau cov ntaub ntawv thiab PeterSchaffarich rau kev xa cov ntaub ntawv khaws cia scintigraphic duab.

Nyiaj txiag

Cov nyiaj qhib qhib yog muab los ntawm Medical University of Vienna.

Kev tsis sib haum xeeb

M. Hamböck, A. Staudenherz, A. Kainz, B. Geist, M. Hecking, K. Doberer, M. Hacker, thiab GA Böhmig tshaj tawm tias lawv tsis muaj kev nyiam sib tw.

cistanche deserticola cov txiaj ntsig

Cov ntaub ntawv

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