Maffei C, Sandrini S, Galanopoulou A, Bossini N, Setti G, Iovinella L, Turina S, Cancarini G
Transplantation Unit, Nephrology Spedali Civili of Brescia, Brescia, Italy.
Transplant Proc. 2008 Jul-Aug;40(6):1862-4. doi: 10.1016/j.transproceed.2008.05.046.
The benefits of kidney transplantation over dialysis on patient survival have been demonstrated without considering the outcomes of patients with graft loss. To determine whether mortality after graft failure reduced the transplantation advantage in patient survival, we retrospectively reviewed the outcomes of 918 first-deceased renal transplant recipients from May 1979 to August 2005. Patient survivals were 88% and 72% at 10 and 20 years; cancer (26%) and cardiovascular disease (25%) were the major causes of death. Graft survivals were 72% and 50% at 10 and 20 years; chronic rejection was the major cause of graft loss (50%). Patient outcomes after return to dialysis were reviewed in 224 of 240 patients. The survivals were 97%, 83%, and 70% at 1, 5, and 10 years, respectively; cardio-cerebrovascular disease (56%), infections (9%), cachexia (9%), and cancer (8%) were the major causes of death. Mortality correlated with patient age at transplantation (P< .001). Re-listed patients (96 of 224) were younger (32+/-10 vs 43+/-11 years; P< .001), had a shorter dialysis period pretransplant (3.2+/-3.1 vs 4.3+/-3.9 years; P< .03), and a better survival at 10 years (98% vs 56%; P< .001). Ten-year mortality for patients who returned to dialysis was 20% higher than for patients with a functioning graft (P< .001). The reduction in overall patient survival was 2.2% at 10 years (P=NS), 5% at 15 years (P=NS), and 14% at 20 years (P< .05). The same results have been demonstrated for patients >50 years at transplantation. In conclusion, the mortality rate after return to dialysis did not influence the long-term benefits of kidney transplantation.
在不考虑移植肾失功患者结局的情况下，肾移植相对于透析在患者生存方面的益处已得到证实。为了确定移植失败后的死亡率是否会降低肾移植在患者生存方面的优势，我们回顾性分析了1979年5月至2005年8月期间918例首次接受尸体肾移植受者的结局。患者10年和20年的生存率分别为88%和72%；癌症（26%）和心血管疾病（25%）是主要死因。移植肾10年和20年的生存率分别为72%和50%；慢性排斥是移植肾失功的主要原因（50%）。在240例患者中的224例患者恢复透析后的结局进行了评估。1年、5年和10年的生存率分别为97%、83%和70%；心脑血管疾病（56%）、感染（9%）、恶病质（9%）和癌症（8%）是主要死因。死亡率与移植时患者年龄相关（P<0.001）。再次列入移植名单的患者（224例中的96例）更年轻（32±10岁对43±11岁；P<0.001），移植前透析时间更短（3.2±3.1年对4.3±3.9年；P<0.03），10年生存率更高（98%对56%；P<0.001）。恢复透析患者的10年死亡率比移植肾功能正常患者高20%（P<0.001）。患者总体生存率在10年时降低2.2%（P=无统计学意义），15年时降低5%（P=无统计学意义），20年时降低14%（P<0.05）。对于移植时年龄>50岁的患者也得到了相同的结果。总之，恢复透析后的死亡率并未影响肾移植的长期益处。
