Schweitzer E J, Matas A J, Gillingham K J, Payne W D, Gores P F, Dunn D L, Sutherland D E, Najarian J S
Department of Surgery, University of Minnesota, Minneapolis.
Ann Surg. 1991 Dec;214(6):679-88. doi: 10.1097/00000658-199112000-00007.
A variety of refinements in the care of kidney transplant recipients have been instituted over the past decade. The authors studied the overall impact of these refinements on kidney allograft losses at a single institution. To do this they compared the causes and rates of graft loss for primary kidney transplants in the 1970s (January 1, 1970 to December 31, 1979; n = 1012; 657 nondiabetics, 355 diabetics; 617 living donors, 395 cadaver donors) versus the 1980s (January 1, 1980 to December 31, 1989; n = 1,384; 756 nondiabetics, 628 diabetics; 740 living donors, 644 cadaver donors). Overall patient survival improved significantly, with rates at 1, 5, and 10 years of 94%, 84%, and 68% for the 1980s, compared with 86%, 69%, and 57% for the 1970s (p less than 0.001). Actuarial graft survival also improved significantly, with rates at 1, 5, and 10 years of 86%, 71%, and 52% for the 1980s, compared with 73%, 58%, and 43% for the 1970s (p less than 0.001). This improvement occurred even though there were proportionately more cadaver donors and diabetic recipients in the 1980s. For both decades combined, 24% of the lost grafts were due to chronic rejection, 18% to cardiovascular causes of death with function, 13% to infectious causes of death with function, and 11% to acute rejection. The overall gain in graft survival rates in the 1980s was principally due to fewer cases of acute rejection and fewer infectious deaths. Improvement in graft survival due to the two leading causes--chronic rejection and cardiovascular causes of death--was relatively small, if any. These data indicate that future kidney transplantation research should emphasize prevention of chronic rejection and cardiovascular death.
在过去十年中，针对肾移植受者的护理采取了多种改进措施。作者在单一机构研究了这些改进措施对肾移植失败的总体影响。为此，他们比较了20世纪70年代（1970年1月1日至1979年12月31日；n = 1012；657名非糖尿病患者，355名糖尿病患者；617名活体供者，395名尸体供者）与20世纪80年代（1980年1月1日至1989年12月31日；n = 1384；756名非糖尿病患者，628名糖尿病患者；740名活体供者，644名尸体供者）原发性肾移植的移植失败原因和发生率。总体患者生存率显著提高，20世纪80年代1年、5年和10年的生存率分别为94%、84%和68%，而20世纪70年代分别为86%、69%和57%（p<0.001）。移植精算生存率也显著提高，20世纪80年代1年、5年和10年的生存率分别为86%、71%和52%，而20世纪70年代分别为73%、58%和43%（p<0.001）。尽管20世纪80年代尸体供者和糖尿病受者的比例相对较高，但仍有这样的改善。在这两个十年中，24%的移植失败是由于慢性排斥反应，18%是由于伴有功能的心血管死亡原因，13%是由于伴有功能的感染性死亡原因，11%是由于急性排斥反应。20世纪80年代移植生存率的总体提高主要是由于急性排斥反应病例减少和感染性死亡减少。由两个主要原因——慢性排斥反应和心血管死亡原因——导致的移植生存率的提高（如果有的话）相对较小。这些数据表明，未来肾移植研究应强调预防慢性排斥反应和心血管死亡。
