Chang Sean H, Russ Graeme R, Chadban Steven J, Campbell Scott B, McDonald Stephen P
Australia and New Zealand Dialysis and Transplant Registry, Queen Elizabeth Hospital, Woodville South, Australia.
Transplantation. 2007 Sep 15;84(5):611-8. doi: 10.1097/01.tp.0000280553.23898.ef.
We hypothesize that transplant outcome in Australia and New Zealand has improved despite more unfavorable transplant characteristics. Data from the Australia and New Zealand Dialysis and Transplant registry was used to examine this hypothesis.
All adult kidney-only transplants from January 1993 to December 2004 in Australia or New Zealand were followed-up until death or December 2005. Outcomes were adjusted for covariates in multivariate models, with transplant year modeled as a continuous variable.
Altogether 6764 patients were included. There were proportionately more live donor and primary transplants, older donors and recipients, and higher recipient body mass index, waiting time, and human leukocyte antigen mismatch in recent cohorts. Death-censored graft loss decreased (adjusted hazard ratio: 0.92 [0.90-0.95] per year, P<0.001). This trend was seen at both 0-1 and 1-5 years posttransplant, and was mainly for immune-mediated graft losses. Patient survival improved only in New Zealand, and only for the first posttransplant year (adjusted odds ratio: 0.88 [0.82-0.95] per year, P=0.001). Cardiovascular deaths decreased while infection or cancer deaths were unchanged. Adjusted delayed graft function rates were unchanged. The acute rejection incidence at 6 months decreased (adjusted odds ratio: 0.88 [0.85-0.90] per year, P<0.001). One and 3-year graft function significantly improved, even after adjusting for rejection. All outcomes did not vary by expanded donor criteria status.
Graft survival and function have improved in recent years, but long-term patient survival remains unchanged. With longer follow-up, the improvement in rejection rates and graft function may lead to further improvements in long-term graft survival and potentially better patient survival.
我们推测，尽管移植特征更不理想，但澳大利亚和新西兰的移植结果仍有所改善。利用澳大利亚和新西兰透析与移植登记处的数据来检验这一推测。
对1993年1月至2004年12月在澳大利亚或新西兰进行的所有仅肾移植的成年患者进行随访，直至死亡或2005年12月。在多变量模型中对结果进行协变量调整，将移植年份建模为连续变量。
共纳入6764例患者。在最近的队列中，活体供体和初次移植、年龄较大的供体和受体、较高的受体体重指数、等待时间以及人类白细胞抗原错配的比例更高。死亡删失的移植物丢失率下降（调整后的风险比：每年0.92[0.90 - 0.95]，P<0.001）。这种趋势在移植后0 - 1年和1 - 5年都可见，且主要是免疫介导的移植物丢失。仅在新西兰患者生存率有所改善，且仅在移植后的第一年（调整后的优势比：每年0.88[0.82 - 0.95]，P = 0.001）。心血管死亡人数减少，而感染或癌症死亡人数未变。调整后的延迟移植肾功能发生率未变。6个月时的急性排斥反应发生率下降（调整后的优势比：每年0.88[0.85 - 0.90]，P<0.001）。即使在调整排斥反应后，1年和3年的移植肾功能也显著改善。所有结果在扩大供体标准状态方面没有差异。
近年来移植物存活和功能有所改善，但长期患者生存率保持不变。随着随访时间延长，排斥反应率和移植肾功能的改善可能会导致长期移植物存活进一步改善，并可能使患者生存率提高。
