Cicciarelli J, Iwaki Y, Mendez R
USC Metic Transplantation Lab, Los Angeles, USA.
Clin Transpl. 1999:335-40.
Based on analyses of the UNOS Registry data for cadaver kidney transplants performed between 1991-1999 we showed that: 1. 15-40 year old donor kidneys provided the best one-year graft survival rates. When donors were analyzed with recipients, younger (0-10) and older (70-90) donors and recipients (Table 2) had the lowest one-year graft success rates. 2. Chronic loss rate, the constant rate of graft loss between one and 5 years, showed younger donor kidneys had a significantly lower chronic loss rate compared with each older donor category. Apparently the younger donor kidneys have a resiliency and nephron reserve that provides better long-term function. However, they may have lower short-term (1-yr) graft survival rates, possibly due to their small size. 3. Black and White donor kidneys had similar one-year graft survival rates; however, in every age group, recipients of White donor kidneys had significantly better 5-year graft survival rates than Black donor kidneys. There was also a noticeably lower chronic loss rate among recipients of White than Black donor kidneys. 4. HLA-matched White donor kidneys had better one- and 5-year graft survival rates and lower chronic loss rates than HLA-mismatched kidneys. The matching effect was lost when the donor age increased beyond age 40. PRA had an effect both at one and 5 years after transplantation. The chronic loss rate was similar with high and low PRA. Therefore, PRA had a relatively short-term effect. 5. Cold ischemia time had a modest effect after 35 hours both at one and 5 years. However, the chronic loss rate was unaffected by CIT, suggesting prolonged ischemia time had a relatively short-term effect. 6. More focused attention on sensitization and lowered CIT can both have a significant effect on short-term graft survival rates. However, both matching and younger donor organs provide the best opportunity for better long-term graft success rates.
基于对1991年至1999年间进行的尸体肾移植的美国器官共享联合网络（UNOS）登记数据的分析，我们发现：1. 15至40岁供体的肾脏提供了最佳的一年移植肾存活率。当对供体和受体进行分析时，年龄较小（0至10岁）和较大（70至90岁）的供体及受体（表2）的一年移植成功率最低。2. 慢性丢失率，即移植后1至5年期间移植肾持续丢失的速率，显示与各年龄较大的供体类别相比，年龄较小的供体的肾脏慢性丢失率显著更低。显然，年龄较小的供体的肾脏具有更强的恢复力和肾单位储备，能提供更好的长期功能。然而，它们的短期（1年）移植肾存活率可能较低，这可能是由于其体积较小。3. 黑人和白人供体的肾脏一年移植肾存活率相似；然而，在每个年龄组中，接受白人供体肾脏的受体的5年移植肾存活率显著高于接受黑人供体肾脏的受体。白人供体肾脏受体的慢性丢失率也明显低于黑人供体肾脏受体。4. 与HLA不匹配的肾脏相比，HLA匹配的白人供体肾脏具有更好的一年和5年移植肾存活率以及更低的慢性丢失率。当供体年龄超过40岁时，匹配效果消失。移植后1年和5年时群体反应性抗体（PRA）均有影响。高PRA和低PRA时慢性丢失率相似。因此，PRA的影响相对较短期。5. 冷缺血时间在35小时后对1年和5年时均有适度影响。然而，慢性丢失率不受冷缺血时间（CIT）影响，这表明延长的缺血时间影响相对较短期。6. 更多地关注致敏作用和缩短冷缺血时间均可对短期移植肾存活率产生显著影响。然而，匹配和年龄较小的供体器官均为获得更好的长期移植成功率提供了最佳机会。
