Ishani Areef, Ibrahim Hassan N, Gilbertson David, Collins Allan J
Section of Nephrology, Department of Medicine, Minneapolis Veterans Affairs Medical Center, Minneapolis, MN 55417, USA.
Am J Kidney Dis. 2003 Dec;42(6):1275-82. doi: 10.1053/j.ajkd.2003.08.030.
Transplantation before the initiation of dialysis is associated with prolonged allograft survival. It is unclear if this benefit is attributable to greater residual renal function or to avoidance of dialysis exposure. The authors performed an analysis to determine whether higher renal function at transplant was associated with increased patient and graft survival rates.
The authors identified individuals who between 1994 and June 2000 were >or= 18 years and had undergone a living donor renal transplant (Tx) as initial form of renal replacement therapy. Pre-Tx and 6-month estimated glomerular filtration rates (eGFR) were calculated using the 4-variable Modification of Diet in Renal Disease formula. Survival was compared in those with a pre-Tx eGFR >or=15mL/min to those with an eGFR less than 15 mL/min, after adjusting for demographic variables, co-morbidities, and transplant characteristics. Survival rate then was adjusted for calculated propensity scores.
A total of 4,046 patients were included. Mean pre-Tx eGFR was 9.9 mL/min (0.9 to 57.1 mL/min). There was no difference in graft survival rates by strata of eGFR in any of the tested models, even after correcting for propensity score (hazard ratio, 0.95; 95% confidence interval, 0.69 to 1.30). There was no correlation between pre-Tx eGFR and 6-month post-Tx eGFR (r(2) =-0.005).
Recipients of preemptive transplants fare equally, regardless of the eGFR at which they receive their transplant. There was no relationship between pre-Tx eGFR and 6-month eGFR, suggesting that post-Tx renal function is independent of the level of pre-Tx renal function. These data suggest that preemptive kidney transplantation should be delayed as long as possible, provided the patient does not have uremic symptoms, and dialysis can be safely avoided.
在开始透析之前进行移植与同种异体移植物的长期存活相关。目前尚不清楚这种益处是归因于更高的残余肾功能还是避免了透析暴露。作者进行了一项分析，以确定移植时较高的肾功能是否与患者和移植物存活率的提高相关。
作者确定了1994年至2000年6月期间年龄≥18岁且接受活体供肾移植（Tx）作为肾脏替代治疗初始形式的个体。使用四变量肾病饮食改良公式计算移植前和6个月时的估计肾小球滤过率（eGFR）。在调整人口统计学变量、合并症和移植特征后，比较移植前eGFR≥15mL/min者与eGFR低于15mL/min者的存活率。然后根据计算出的倾向得分调整存活率。
共纳入4046例患者。移植前eGFR的平均值为9.9 mL/min（0.9至57.1 mL/min）。在任何测试模型中，即使校正倾向得分后，不同eGFR分层的移植物存活率也没有差异（风险比，0.95；95%置信区间，0.69至1.30）。移植前eGFR与移植后6个月eGFR之间无相关性（r(2)= -0.005）。
抢先移植的受者情况相同，无论其接受移植时的eGFR如何。移植前eGFR与6个月时的eGFR之间没有关系，这表明移植后肾功能独立于移植前肾功能水平。这些数据表明，只要患者没有尿毒症症状且可安全避免透析，抢先肾移植应尽可能推迟。
