Lin Shih-jui, Koford James K, Baird Bradley C, Habib Arsalan N, Reznik Ilya, Chelamcharla Madhukar, Shihab Fuad S, Goldfarb-Rumyantzev Alexander S
Department of Medical Informatics, University of Utah, Salt Lake City, USA.
Clin Transplant. 2006 Mar-Apr;20(2):245-52. doi: 10.1111/j.1399-0012.2005.00476.x.
There has been a general trend towards shortened length of post-kidney transplant hospitalization (LOH). The decision regarding patients's discharge from the hospital theoretically may be based on several factors, including, but not limited to, patient well being, insurance status, family situation and other, mostly socio-economic factors, as opposed to hard medical evidence. However, the appropriate LOH in kidney transplant recipients is not well studied regarding long-term outcomes.
This study retrospectively analysed the association between LOH and graft and recipient survival based on United States Renal Data System dataset. In total, 100,762 patients who underwent transplant during 1995-2002 were included. Kaplan-Meier survival analysis and Cox models were applied to the whole patient cohort and on sub-groups stratified by the presence of delayed graft function, patient comorbidity index and donor type (deceased or living).
In recipient survival, both short (<4 d) and long (>5 d) LOH showed a significant adverse effect (p < 0.01) on survival times. In the analysis of graft survival, long LOH (>or=2 wk) also showed significant adverse effects (p < 0.001) on survival times. However, short LOH (<4 d) did not reach statistical significance, although it was still associated with adverse effects on graft survival. These observations were consistent across the whole patient cohort and sub-groups stratified by the presence of delayed graft function, patient comorbidity index and donor type.
Clinical considerations should be used to make the decision regarding appropriate time of post-kidney transplant recipient discharge. Based on this study, shorter than four d post-kidney transplant hospitalization may potentially be harmful to long-term graft and recipient survival.
肾移植术后住院时间（LOH）有缩短的总体趋势。理论上，关于患者出院的决定可能基于多种因素，包括但不限于患者的健康状况、保险状况、家庭情况以及其他主要是社会经济因素，而非确凿的医学证据。然而，肾移植受者的合适住院时间在长期预后方面并未得到充分研究。
本研究基于美国肾脏数据系统数据集，回顾性分析了住院时间与移植物及受者存活之间的关联。总共纳入了1995年至2002年期间接受移植的100762例患者。将Kaplan-Meier生存分析和Cox模型应用于整个患者队列以及根据移植肾功能延迟情况、患者合并症指数和供体类型（已故或活体）分层的亚组。
在受者存活方面，短住院时间（<4天）和长住院时间（>5天）均对存活时间有显著不利影响（p<0.01）。在移植物存活分析中，长住院时间（≥2周）也对存活时间有显著不利影响（p<0.001）。然而，短住院时间（<4天）虽仍与移植物存活的不利影响相关，但未达到统计学显著性。这些观察结果在整个患者队列以及根据移植肾功能延迟情况、患者合并症指数和供体类型分层的亚组中均一致。
应运用临床考量来决定肾移植受者的合适出院时间。基于本研究，肾移植术后住院时间短于4天可能对移植物和受者的长期存活有潜在危害。
