Kessler Michèle, Virion Jean-Marc, Hachicha Mourad, Moulin Bruno, Toupance Olivier, Rebibou Jean-Michel, Guillemin Francis
Department of Nephrology, Nancy, France.
Nephrol Dial Transplant. 2008 Mar;23(3):1054-60. doi: 10.1093/ndt/gfm709. Epub 2007 Oct 30.
Since 1996, the allocation of grafts in France has been based on a hierarchical three-level system: national, regional and local. The objective of this study was to determine whether the shipment of cadaveric kidneys according to these new exchange rules affects allograft outcome in the Eastern region of France.
This retrospective study analysed all renal transplants performed in the four centres of the French Eastern region during 3 years (1996 to 1998). All patients were followed up until death, return to dialysis, last information date or the end of June 2003. Information regarding the donors, recipients and treatments, as well as patient and graft outcome, was recorded. Factors associated with graft loss were analysed using Cox proportional hazard methods.
542 transplants were analysed, 287 (53%) kidneys were transplanted locally, 229 (42.2%) kidneys coming from exchanges within the region and 26 (4.8%) from another region. There were statistically significant differences between the four centres for donors' and recipient' characteristics and for immunosuppressive treatment, but there was no difference between centres regarding patient survival (94.4% at 5 years), graft survival (83.7% at 5 years) or death-censored graft survival (87.8% at 5 years). Compared to locally transplanted grafts, shipped grafts had significantly better human leukocyte antigen (HLA) matching (2.5 +/- 1.3 versus 2.1 +/- 1.0 matches, P = 0.0005 but a longer cold ischaemia time (23.2 +/- 7.9 versus 19.2 +/- 7.8 h, P < 0.0001). Three independent factors were associated with a reduced graft survival: at least one acute rejection, delayed graft function and a shipped graft.
The results of this study suggest that the shipment of cadaveric renal allografts in a regional distribution system is associated with better HLA matching but is a significant predictor of graft loss at 5 years. It would be advisable to restrict graft sharing to patients whose access to transplantation is limited, taking special care to avoid any additional factors having a detrimental effect on the outcome.
自1996年以来，法国的器官移植分配基于一个三级分层系统：全国、地区和地方。本研究的目的是确定根据这些新的交换规则运送尸体肾是否会影响法国东部地区同种异体移植的结果。
这项回顾性研究分析了法国东部地区四个中心在3年（1996年至1998年）期间进行的所有肾移植。所有患者均随访至死亡、恢复透析、最后一次信息日期或2003年6月底。记录了有关供体、受体和治疗的信息，以及患者和移植物的结局。使用Cox比例风险方法分析与移植物丢失相关的因素。
分析了542例移植，287例（53%）肾脏在当地移植，229例（42.2%）肾脏来自地区内交换，26例（4.8%）来自其他地区。四个中心在供体和受体特征以及免疫抑制治疗方面存在统计学显著差异，但在患者生存率（5年时为94.4%）、移植物生存率（5年时为83.7%）或死亡审查移植物生存率（5年时为87.8%）方面中心之间没有差异。与当地移植的移植物相比，运送的移植物具有显著更好的人类白细胞抗原（HLA）匹配（2.5±1.3对2.1±1.0匹配，P = 0.0005），但冷缺血时间更长（23.2±7.9对19.2±7.8小时，P < 0.0001）。三个独立因素与移植物生存率降低相关：至少一次急性排斥反应、移植肾功能延迟和运送的移植物。
本研究结果表明，在区域分配系统中运送尸体肾同种异体移植物与更好的HLA匹配相关，但在5年时是移植物丢失的重要预测因素。建议将移植物共享限制于移植机会有限的患者，并特别注意避免任何对结局有不利影响的额外因素。
