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Hemodialysis arteriovenous fistula ligation after renal transplantation: Impact on graft resistive index.

肾移植后血液透析动静脉内瘘结扎术: 对移植物阻力指数的影响。

  • 影响因子:1.12
  • DOI:10.1177/1129729820927240
  • 作者列表:"Magnetti M","Leonardi G","Guarena C","Dolla C","Tarragoni R","Abbasciano I","Fop F","Tallia C","Giordano F","Verri A","Biancone L
  • 发表时间:2021-01-01
Abstract

BACKGROUND:Kidney allograft resistive index (RI) is prognostic for graft and recipient survivals. Recipient hemodynamics could influence RI. In particular, dialysis arteriovenous fistula (AVF) has been involved in heart function changes, reversible after AVF ligation. Knowledge about AVF and RI is lacking. In this study, we prospectively evaluated RI changes after AVF ligation in kidney transplanted patients. METHODS:We enrolled 22 stable transplanted patients. Mean RI was measured before AVF ligation (T0), 18 to 24 h (T1) and 6 months (T6) after surgery; mean blood pressure (mBP), heart rate (HR), serum creatinine (sCr), estimated glomerular filtration rate (eGFR), 24 h proteinuria (24 h-P), immunosuppressive drug blood levels (IS) and antihypertensive drugs were also recorded. RESULTS:AVF ligation was performed 3.1 years (IQR: 2.1-3.8) after transplantation. Median AVF flow (Qa) was 1868 mL/min (IQR: 1538-2712) and 8 AVF were classified as high flow (Qa ≥ 2 L/min). At baseline, median sCr was 1.32 mg/dL (IQR: 1.04-1.76) and median eGFR was 57.1 mL/min. Median RI was 0.71 at T0, 0.69 at T1, 0.66 at T6. RI reduction at T1 and T6 was statistically significant (p < 0.05 and p < 0.001 respectively); in particular, 90.4% of patients had persistently improved values at T6. Furthermore, mBP increased while HR decreased. These changes were independent from sCr, 24 h-P, IS, antihypertensive drugs number, Qa and AVF type. CONCLUSIONS:AVF ligation improves kidney allograft RI; it may reflect better kidney perfusion.

摘要

背景: 肾移植阻力指数 (RI) 是移植物和受体存活的预后指标。受体血流动力学可影响RI。特别地,透析动静脉瘘 (AVF) 已经涉及心脏功能改变,AVF结扎后是可逆的。缺乏关于AVF和RI的知识。在这项研究中,我们前瞻性地评估肾移植患者AVF结扎后的RI变化。 方法: 我们纳入了22例稳定的移植患者。AVF结扎前 (T0) 、术后18 ~ 24 h (T1) 、术后6个月 (T6) 测量平均RI; 平均血压 (mBP) 、心率 (HR) 、血清肌酐 (sCr) 、估计肾小球滤过率 (eGFR) 、24 h蛋白尿 (24 h-P),同时记录免疫抑制药物血药浓度 (IS) 和抗高血压药物。 结果: 移植后3.1年 (IQR: 2.1-3.8) 进行AVF结扎。中位AVF流量 (Qa) 为1868 ml/min (IQR: 1538-2712),8 AVF被分类为高流量 (Qa ≥ 2 l/min)。在基线时,中位sCr为1.32 mg/dL (IQR: 1.04-1.76),中位eGFR为57.1 ml/min。中位RI在T0为0.71,T1为0.69,t6为0.66。T1和T6时的RI降低具有统计学显著性 (分别为p <0.05和p <0.001); 特别是,90.4% 的患者在T6时具有持续改善的值。此外,mBP增加而HR降低。这些变化与sCr、24 h-P、IS、抗高血压药物数量、Qa和AVF类型无关。 结论: AVF结扎改善了移植肾RI,可能反映了更好的肾脏灌注。

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