Goldfarb-Rumyantzev Alexander S, Hurdle John F, Baird Bradley C, Stoddard Greg, Wang Zhi, Scandling John D, Barenbaum Lev L, Cheung Alfred K
Division of Nephrology, University of Utah Health School of Medicine, Salt Lake City, UT 84112, USA.
Nephrol Dial Transplant. 2006 May;21(5):1355-64. doi: 10.1093/ndt/gfk061. Epub 2006 Feb 13.
The effect of the pre-emptive re-transplant, and of inter-transplant waiting time generally, on graft and recipient survival is not well established.
Analysis of the United States Renal Data System (USRDS) data (1/1/90 through 12/31/00; n = 92,844) was performed. Cox regression was used to analyse time to event, with an additional analysis to stratify by transplant era.
Having a prior transplant, as well as the total number of transplants, was related to an increased risk of graft failure [hazard ratio (HR) 1.24, P<0.001 for history of prior transplant; HR 1.35 per transplant, P<0.001], but not to recipient death. The time waiting for re-transplant slightly worsened the risk for recipient mortality in the entire patient population and in the recipients of single re-transplant (HR 1.003 and 1.004 per month respectively, P<0.001), and for graft failure only in recipients of single re-transplant (HR 1.001 per month, P<0.05). Pre-emptive re-transplant (dialysis-free re-transplant or transplant within 6 days of last graft failure) increased the risk of graft failure (HR 1.36, P<0.001) and did not have any statistically significant effect on recipient survival. The longer duration of prior graft survival but not the type of the graft (living vs deceased) had protective effect on the consecutive graft and recipient survival.
With the potential caveats associated with retrospective data analysis, these results suggest that pre-emptive re-transplantation is associated with increased risk of graft failure, while longer time on dialysis in between transplants is associated with negative effect upon graft and recipient survival in most patient subgroups. The optimal time in between graft failure and re-transplant was not evaluated in this study. Further prospective studies might be needed to confirm the observed effects.
预先进行再次移植以及一般的移植间隔等待时间对移植物和受者存活的影响尚未完全明确。
对美国肾脏数据系统（USRDS）的数据（1990年1月1日至2000年12月31日；n = 92,844）进行分析。采用Cox回归分析事件发生时间，并通过移植时代进行分层的额外分析。
既往有过移植以及移植总数与移植物失败风险增加相关[风险比（HR）1.24，既往移植史P<0.001；每次移植HR 1.35，P<0.001]，但与受者死亡无关。再次移植等待时间在整个患者群体以及单次再次移植受者中，会使受者死亡风险略有增加（分别为每月HR 1.003和1.004，P<0.001），且仅在单次再次移植受者中会使移植物失败风险增加（每月HR 1.001，P<0.05）。预先进行再次移植（无透析再次移植或在上次移植物失败后6天内进行移植）会增加移植物失败风险（HR 1.36，P<0.001），且对受者存活无任何统计学上的显著影响。既往移植物存活时间较长而非移植物类型（活体与尸体）对后续移植物和受者存活具有保护作用。
鉴于回顾性数据分析存在的潜在问题，这些结果表明，预先进行再次移植与移植物失败风险增加相关，而移植间隔期间透析时间较长在大多数患者亚组中对移植物和受者存活具有负面影响。本研究未评估移植物失败与再次移植之间的最佳时间。可能需要进一步的前瞻性研究来证实所观察到的影响。
