Cacho D T, Piqué A A, Cusi L I P, Reyes L I, Salinas F O, del Pozo R G
Department of Urology, Servei d'Urologia i Transplantament Renal, Hospital Clinic i Provincial, Barcelona, Spain.
Transplant Proc. 2005 Nov;37(9):3679-81. doi: 10.1016/j.transproceed.2005.10.071.
Living donor renal transplantation is a treatment option for patients on dialysis in view of the ever-growing transplantation waiting lists and the stagnation in the number of deceased donors.
The objectives of this study were to provide retrospective review of our living donor kidney transplantation series (1978-2003) and analysis of graft survival prognostic factors.
Among 121 living donor transplantations, the donor mean age was 50.9 years (SD, 1.53) and recipient mean age was 30.4 years (SD, 1.4). Eighty-eight percent of donors were women, 90% were related: siblings 21%, parents 69%, and spouses 6.6%. Kidney failure was of nephrological etiology in 65% of patients and urologic in 15.6%. Eighty-four percent were primary grafts and 16% were second ones. Also, 66.7% of kidneys were placed in the iliac fossa and the rest were left orthotopic approaches. Other analyzed variables included donor gender, acute rejection episodes (ARE), creatinine levels at 1 and 6 months, hypertension (HT), and pediatric recipients.
Univariate analysis (Kaplan-Meier) showed that, in patients suffering from ARE or not, the mean graft survival was 7.5 and 15 years, respectively (P <.05). Mean graft survival among patients with nephrological problems was 8 years and in those with urologic etiology 15 years (P < .05). Multivariate analysis with Cox regression showed that etiology, ARE, and creatinine level at 6 months after transplantation were independent prognostic variables for graft failure. The overall graft survival rates were 78% at 5 years, 58% at 10 years, 42% at 15 years, and 24% at 20 years follow-up.
Living donor kidney transplantation is a valid treatment choice for end-stage patients with excellent graft survival rates, especially in cases of urologic etiology. Development of new immunosupressant strategies will help improve outcomes.
鉴于移植等待名单不断增加以及 deceased 供体数量停滞不前，活体供肾移植是透析患者的一种治疗选择。
本研究的目的是对我们的活体供肾移植系列（1978 - 2003 年）进行回顾性分析，并分析移植肾存活的预后因素。
在 121 例活体供肾移植中，供体平均年龄为 50.9 岁（标准差，1.53），受体平均年龄为 30.4 岁（标准差，1.4）。88%的供体为女性，90%为亲属供体：兄弟姐妹占 21%，父母占 69%，配偶占 6.6%。65%的患者肾衰竭病因是肾脏疾病，15.6%是泌尿系统疾病。84%是初次移植，16%是再次移植。此外，66.7%的肾脏置于髂窝，其余采用原位移植方法。其他分析变量包括供体性别、急性排斥反应发作（ARE）、1 个月和 6 个月时的肌酐水平、高血压（HT）以及儿科受体。
单因素分析（Kaplan - Meier）显示，有或无 ARE 的患者，移植肾平均存活时间分别为 7.5 年和 15 年（P <.05）。肾脏疾病患者的移植肾平均存活时间为 8 年，泌尿系统病因患者为 15 年（P <.05）。Cox 回归多因素分析显示，病因、ARE 和移植后 6 个月时的肌酐水平是移植肾失功的独立预后变量。随访 5 年、10 年、15 年和 20 年时，总体移植肾存活率分别为 78%、58%、42%和 24%。
活体供肾移植是终末期患者有效的治疗选择，移植肾存活率高，尤其是泌尿系统病因的情况。新免疫抑制剂策略的开发将有助于改善治疗效果。
