Ishitani M, Isaacs R, Norwood V, Nock S, Lobo P
Mayo Clinic and Mayo Foundation, Rochester, Minnesota, USA.
Transplantation. 2000 Jul 27;70(2):288-92. doi: 10.1097/00007890-200007270-00008.
A successful kidney transplant from a living-related donor (LRD) remains the most effective renal replacement therapy for children with end-stage renal failure. The use of LRD kidneys results in decreased time on dialysis, increased graft survival, and better function compared with kidneys transplanted from cadaver donors. We retrospectively analyzed data from the United Network of Organ Sharing (UNOS) Scientific Renal Transplant Registry to determine risk factors for graft loss in children who received an LRD kidney.
Data was obtained from the UNOS Scientific Renal Transplant Registry on 2418 children ranging in age from 0 to 18 years who underwent an LRD kidney transplantation between January 1988 and December 1994. Multivariate analysis of graft survival was performed using Kaplan-Meier and Cox regression models.
The effects of age, pretransplantation dialysis, early rejection, and race were found to significantly affect graft survival. Gender, peak panel-reactive antibody, and ABO blood type were not found to be significant risk factors. Infants <2 years of age initially had the worst graft survival; however, over time their results stabilized, and at 7 years estimated graft survival was good (71%). Adolescents ranging in age from 13-18 years had the best initial graft survival, but as time went on graft survival worsened (55%). Patients who underwent pretransplantation dialysis had a relative risk for graft loss of 1.77 (P<0.001), whereas those who had an early rejection had a relative risk for graft loss of 1.41 (P<0.002). African-Americans had a significantly higher relative risk for graft loss than either Caucasians (1.57, P<0.0005) or Hispanics (2.01, P<0.0003).
Predictors of graft survival for children who receive LRD kidney transplants include age at transplantation, pretransplantation dialysis, early rejection, and race. Over time, adolescents and African-Americans seem to have the lowest graft survival.
成功的亲属活体供肾移植仍是终末期肾衰竭儿童最有效的肾脏替代治疗方法。与尸体供肾移植相比，亲属活体供肾移植可缩短透析时间，提高移植肾存活率，并改善肾功能。我们对器官共享联合网络（UNOS）科学肾脏移植登记处的数据进行回顾性分析，以确定接受亲属活体供肾移植儿童移植肾丢失的危险因素。
从UNOS科学肾脏移植登记处获取1988年1月至1994年12月期间接受亲属活体供肾移植的2418例0至18岁儿童的数据。使用Kaplan-Meier和Cox回归模型对移植肾存活率进行多变量分析。
发现年龄、移植前透析、早期排斥反应和种族对移植肾存活率有显著影响。性别、群体反应性抗体峰值和ABO血型不是显著的危险因素。2岁以下婴儿最初的移植肾存活率最差；然而，随着时间推移，其结果趋于稳定，7年时估计移植肾存活率良好（71%）。13至18岁的青少年最初的移植肾存活率最佳，但随着时间推移移植肾存活率下降（55%）。接受移植前透析的患者移植肾丢失的相对风险为1.77（P<0.001），而发生早期排斥反应的患者移植肾丢失的相对风险为1.41（P<0.002）。非裔美国人移植肾丢失的相对风险显著高于白种人（1.57，P<0.0005）或西班牙裔（2.01，P<0.0003）。
接受亲属活体供肾移植儿童移植肾存活的预测因素包括移植时年龄、移植前透析、早期排斥反应和种族。随着时间推移，青少年和非裔美国人的移植肾存活率似乎最低。
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