Abstract:

Objective To analyze the impact of donor kidney Remuzzi score on short-term prognosis inadult single transplant recipients and identify independent risk factors for poor estimated glomerular filtration rate（eGFR，calculated using the CKD-EPI formula based on serum creatinine）recovery at 3 months post-transplant based on the Remuzzi scoring system. Methods Retrospective analysis of clinical data of 153 recipients at Southern Hospital of Southern Medical University from August 2021 to December 2023. Recipients were stratified by age into ＜ 50 years（n ＝ 98）group and ≥ 50 years（n ＝ 55）group，and each group was further divided into high Remuzzi score（＞ 3 points）group and low Remuzzi score（≤ 3 points）group. Dynamic eGFR（CKD-EPI formula）changes and post-transplant adverse events within 3 months，including post-transplant diabetes mellitus（PTDM）， urinary tract infection（UTI），viral infections〔cytomegalovirus（CMV），JC virus（JCV），BK polyomavirus（BKV）〕， delayed graft function（DGF），proteinuria，acute rejection，were compared between groups. Binary logistic regression was used to analyze risk factors for eGFR ＜ 60 ml/（min·1.73 m2 ）at 3 months post-transplant. Results In caseswith recipient age ＜ 50 years，the high Remuzzi score group exhibited significantly lower mean eGFR at 1 month （P ＝ 0.024）and 3 months（P ＜ 0.001）. Similar trends were observed in cases with recipient age ≥ 50 years （1 month ：P ＝ 0.003 ；3 months ：P ＝ 0.014）. Multivariate analysis identified Remuzzi score（OR ＝ 1.384，P ＝ 0.001）and recipient age（OR ＝ 1.052，P ＝ 0.006）as independent risk factors for poor eGFR recovery at 3 months post-transplant. Within the first 3 months post-transplant，recipients aged ＜ 50 years in the high Remuzzi score group exhibited a significantly higher incidence of JCV infection compared to the low Remuzzi score（21.1%vs. 3.8%，P ＝ 0.025）. However，no significant differences were observed between the groups in the incidence of PTDM，UTI，BKV infection，CMV infection，DGF，proteinuria，or acute rejection（all P ＞ 0.05）. In recipients aged ≥ 50 years，none of the adverse events demonstrated significant differences between the high- and low- score groups（all P ＞ 0.05）. Conclusion A donor kidney Remuzzi score ＞ 3 points independently predicts poor graft function recovery〔eGFR ＜ 60ml/（min·1.73 m2 ）〕at 3 months post-transplant in adult single transplant recipients. Combined with recipient age and donor kidney quality assessment，it facilitates postoperative risk stratification. Although the Remuzzi score lacks significant predictive value for short-term adverse events such as post-transplant diabetes mellitus and acute rejection，its association with increased JCV infection incidence in recipients ＜ 50 years warrants enhanced infection risk monitoring for high-score donor kidneys. 

Key words:

Kidney transplantation, Remuzziscore, Estimated glomerularfiltration rate, Expanded criteria donor

摘要：

目的 分析供肾 Remuzzi 评分对成人单肾移植受者及移植肾短期预后（术后 3 个月内）的影响，并基于供肾评分体系分析术后 3 个月内基于血清肌酐的估算肾小球滤过率（estimated glomerular filtration rate，eGFR，采用 CKD-EPI 公式计算）恢复不良的独立危险因素。 方法 回顾性分析南方医科大学南方医院 2021 年 8 月至 2023 年 12 月 153 例受者的临床资料。将受者按年龄分层，分为＜ 50 岁组（n ＝ 98）和≥ 50 岁组（n ＝ 55），并进一步根据供肾 Remuzzi 评分将受者分为高分组（Remuzzi 评分＞ 3 分） 和低分组（Remuzzi 评分≤ 3 分），比较术后 3 个月内基于血清肌酐的 eGFR（CKD-EPI 公式）动态变化及受者移植后糖尿病、泌尿系统细菌感染、病毒感染（包括巨细胞病毒感染、JC 病毒感染、BK 病毒感染）、移植肾功能延迟恢复（delayed graft function，DGF）、蛋白尿和急性排斥反应发生率，分析供肾 Remuzzi 评分对成人肾移植短期预后的影响。在此基础上，根据术后第 3 个月时受者 eGFR 恢复情况将其分为eGFR ≥ 60 ml/（min·1.73 m2 ）或 eGFR ＜ 60 ml/（min·1.73 m2 ），采用二元 Logistic 回归分析受者术后第 3 个月移植肾功能恢复的独立危险因素。 结果 受者年龄＜ 50 岁亚组中，Remuzzi 高分组（n ＝ 79）术 后 1 个月（P ＝ 0.024）及 3 个月（P ＜ 0.001）的 eGFR 均值显著低于低分组（n ＝ 19）。受者年龄≥ 50 岁 亚组中，Remuzzi 高分组（n ＝ 27）术后 1 个月（P ＝ 0.003）及 3 个月（P ＝ 0.014）的 eGFR 均值亦显著低 于低分组（n ＝ 28）。多因素分析显示，供肾 Remuzzi 评分（OR ＝ 1.384，P ＝ 0.001）和受者年龄（OR ＝ 1.052，P ＝ 0.006）是术后 3 个月 eGFR 恢复不良的独立危险因素。术后 3 个月内，在受者年龄＜ 50 岁亚组中，高分组 JCV 感染发生率显著增高（21.1% 比 3.8%，P ＝ 0.025），但移植后糖尿病、泌尿系感染、BK 病毒感染、CMV 感染、DGF、蛋白尿和急性排斥反应发生率组间均无统计学差异（P ＞ 0.05）。受者年龄≥ 50 岁亚组中，所有不良事件发生率在高分组与低分组间均无显著差异（P ＞ 0.05）。 结论 供肾 Remuzzi 评分＞ 3 分是成人单肾移植术后 3 个月移植肾功能恢复不良〔eGFR ＜ 60ml/（min·1.73 m2 ）〕的独立预测指标，结合受 者年龄和供肾质量评估有助于术后风险分层。尽管 Remuzzi 评分尚未表现出对短期内移植后糖尿病、急性排斥反应等不良事件的预测能力，但在受者年龄＜ 50 岁亚组中，高评分供肾与 JCV 感染发生率增加相关，需关注此类供肾的感染风险监测。

关键词:

肾移植 , Remuzzi 评分 , 估算肾小球滤过率 , 扩大标准供肾