Meier-Kriesche H U, Port F K, Ojo A O, Rudich S M, Hanson J A, Cibrik D M, Leichtman A B, Kaplan B
Departments of Medicine, Epidemiology and Surgery, The University of Michigan, Ann Arbor, USA.
Kidney Int. 2000 Sep;58(3):1311-7. doi: 10.1046/j.1523-1755.2000.00287.x.
Numerous factors are known to impact on patient survival after renal transplantation. Recent studies have confirmed a survival advantage for renal transplant patients over those waiting on dialysis. We aimed to investigate the hypothesis that longer waiting times are more deleterious than shorter waiting times, that is, to detect a "dose effect" for waiting time.
We analyzed 73,103 primary adult renal transplants registered at the United States Renal Data System Registry from 1988 to 1997 for the primary endpoints of death with functioning graft and death-censored graft failure by Cox proportional hazard models. All models were corrected for donor and recipient demographics and other factors known to affect outcome after kidney transplantation.
A longer waiting time on dialysis is a significant risk factor for death-censored graft survival and patient death with functioning graft after renal transplantation (P < 0.001 each). Relative to preemptive transplants, waiting times of 6 to 12 months, 12 to 24 months, 24 to 36, 36 to 48, and over 48 months confer a 21, 28, 41, 53, and 72% increase in mortality risk after transplantation, respectively. Relative to preemptive transplants, waiting times of 0 to 6 months, 6 to 12 months, 12 to 24 months, and over 24 months confer a 17, 37, 55, and 68% increase in risk for death-censored graft loss after transplantation, respectively.
Longer waiting times on dialysis negatively impact on post-transplant graft and patient survival. These data strongly support the hypothesis that patients who reach end-stage renal disease should receive a renal transplant as early as possible in order to enhance their chances of long-term survival.
已知众多因素会影响肾移植患者的存活。近期研究已证实肾移植患者比等待透析的患者具有存活优势。我们旨在研究等待时间越长比等待时间短更有害这一假设，即检测等待时间的“剂量效应”。
我们分析了1988年至1997年在美国肾脏数据系统登记处登记的73103例原发性成人肾移植病例，采用Cox比例风险模型以移植肾有功能时的死亡和死亡审查的移植肾失功作为主要终点。所有模型均针对供体和受体的人口统计学特征以及其他已知会影响肾移植后结局的因素进行了校正。
透析等待时间越长是肾移植后死亡审查的移植肾存活和移植肾有功能时患者死亡的显著危险因素（每项P<0.001）。相对于抢先移植，等待6至12个月、12至24个月、24至36个月、36至48个月以及超过48个月的患者移植后死亡风险分别增加21%、28%、41%、53%和72%。相对于抢先移植，等待0至6个月、6至12个月、12至24个月以及超过24个月的患者移植后死亡审查的移植肾丢失风险分别增加17%、37%、55%和68%。
透析等待时间越长对移植后移植肾和患者存活产生负面影响。这些数据有力支持了以下假设，即终末期肾病患者应尽早接受肾移植以提高其长期存活几率。
