Orsenigo E, Socci C, Carlucci M, Zuber V, Fiorina P, Gavazzi F, Secchi A, Di Carlo V, Staudacher C
Department of Surgery, Vita e Salute University, San Raffaele Scientific Institute, Milan, Italy.
Transplant Proc. 2005 Jul-Aug;37(6):2461-3. doi: 10.1016/j.transproceed.2005.06.099.
To evaluate factors affecting patient and kidney survival after renal transplant.
Among 361 patients undergoing renal transplant: 52% (n = 189) were simultaneous with pancreas transplant (SPKT group) and 48% (n = 172), a kidney transplant alone (KT group). Out of 361 patients, 75% (n = 270) were diabetics. The patients were 220 (61%) men and 141 (39%) women of mean age 41 +/- 9 years. The mean time of dialysis was 42 +/- 21 months (range 0 to 126), and the mean duration of diabetes 24 +/- 7 years (range 5 to 51). A Cox regression analysis was done.
The multivariate analysis revealed that in the final model diabetes and donor age were significant predictors of kidney graft survival; moreover, diabetes and recipient age were predictors of patient survival. Overall patient survival was significantly greater among nondiabetic patients (P = .002) or in diabetic patients who received SPKT, when compared with diabetics in whom only the kidney was transplanted (P = .001).
Diabetes and donor age were independent prognostic factors affecting kidney graft survival after renal transplant, and recipient age and diabetes were prognostic factors affecting patient survival. Combined pancreas and kidney transplantation should be offered to patients with end-stage diabetic nephropathy.
评估影响肾移植后患者及肾脏存活的因素。
在361例接受肾移植的患者中：52%（n = 189）为胰肾联合移植（SPKT组），48%（n = 172）为单纯肾移植（KT组）。361例患者中，75%（n = 270）为糖尿病患者。患者中有220例（61%）男性和141例（39%）女性，平均年龄41±9岁。平均透析时间为42±21个月（范围0至126个月），平均糖尿病病程为24±7年（范围5至51年）。进行了Cox回归分析。
多因素分析显示，在最终模型中，糖尿病和供体年龄是肾移植存活的显著预测因素；此外，糖尿病和受体年龄是患者存活的预测因素。与仅接受肾移植的糖尿病患者相比，非糖尿病患者（P = .002）或接受SPKT的糖尿病患者的总体患者存活率显著更高（P = .001）。
糖尿病和供体年龄是影响肾移植后肾移植存活的独立预后因素，受体年龄和糖尿病是影响患者存活的预后因素。对于终末期糖尿病肾病患者应提供胰肾联合移植。
