Assuntos
Aloenxertos/metabolismo , Proteína C-Reativa/análise , Função Retardada do Enxerto , Elastase de Leucócito/análise , Transplante de Pulmão , Componente Amiloide P Sérico/análise , Aloenxertos/química , Bronquiolite Obliterante/metabolismo , Proteína C-Reativa/metabolismo , Função Retardada do Enxerto/classificação , Função Retardada do Enxerto/metabolismo , Humanos , Elastase de Leucócito/metabolismo , Pneumopatias/metabolismo , Transplante de Pulmão/classificação , Transplante de Pulmão/estatística & dados numéricos , Metaloproteinase 8 da Matriz/análise , Metaloproteinase 8 da Matriz/metabolismo , Alvéolos Pulmonares/química , Alvéolos Pulmonares/metabolismo , Componente Amiloide P Sérico/metabolismo , Regulação para Cima , alfa-Defensinas/análise , alfa-Defensinas/metabolismoRESUMO
BACKGROUND: The impact of renal function recovery on graft survival was examined using estimated glomerular filtration rate (eGFR) slope after kidney transplantation (GAP classification); this was compared to the conventional classification of immediate graft function (IGF), slow graft function (SGF), and delayed graft function (DGF). MATERIALS AND METHODS: Overall, 541 cases of cadaveric renal transplants were reviewed from a prospective transplant database. eGFR and its slope were measured using the harmonic mean over the first week post-transplantation. Next, 495 kidney transplant recipients from an independent institution were assessed to determine the prognostic value of graft function based on the eGFR slope. RESULTS: The main discrimination of eGFR slopes occurred within the first 7 days. Three groups in the GAP classification (Good graft function, Average graft function, Poor graft function) were defined based on eGFR slope tertiles: good graft function (GGF), average graft function (AGF), and poor graft function (PGF) were defined based on the ΔCrCL per day over the first 7 days: <1 mL/min, 1-4 mL/min, and >4 mL/min, respectively. When applied to the validation cohort, the 5-year graft failure was 20% for the PGF group, 4% for the AGF group, and 3% for the GGF group. Multivariable Cox regression analysis demonstrated better prediction of long-term graft function with the new classification (C statistic 0.49 [old)] vs 0.61 [new]). CONCLUSION: The new GAP criteria were better at predicting long-term graft survival and renal function compared to the conventional classification system, and deserve further consideration in future studies.
