Lonze B E, Warren D S, Stewart Z A, Dagher N N, Singer A L, Shah A S, Montgomery R A, Segev D L
Division of Transplant Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
Am J Transplant. 2009 Mar;9(3):578-85. doi: 10.1111/j.1600-6143.2008.02540.x.
Outcomes after heart and lung transplants have improved, and many recipients survive long enough to develop secondary renal failure, yet remain healthy enough to undergo kidney transplantation. We used national data reported to United Network for Organ Sharing (UNOS) to evaluate outcomes of 568 kidney after heart (KAH) and 210 kidney after lung (KAL) transplants performed between 1995 and 2008. Median time to kidney transplant was 100.3 months after heart, and 90.2 months after lung transplant. Renal failure was attributed to calcineurin inhibitor toxicity in most patients. Outcomes were compared with primary kidney recipients using matched controls (MC) to account for donor, recipient and graft characteristics. Although 5-year renal graft survival was lower than primary kidney recipients (61% KAH vs. 73.8% MC, p < 0.001; 62.6% KAL vs. 82.9% MC, p < 0.001), death-censored graft survival was comparable (84.9% KAH vs. 88.2% MC, p = 0.1; 87.6% KAL vs. 91.8% MC, p = 0.6). Furthermore, renal transplantation reduced the risk of death compared with dialysis by 43% for KAH and 54% for KAL recipients. Our findings that renal grafts function well and provide survival benefit in KAH and KAL recipients, but are limited in longevity by the general life expectancy of these recipients, might help inform clinical decision-making and allocation in this population.
心肺移植后的预后已有所改善，许多受者存活时间足够长，进而发展为继发性肾衰竭，但仍健康到足以接受肾脏移植。我们利用向器官共享联合网络（UNOS）报告的全国性数据，评估了1995年至2008年间进行的568例心脏移植后肾移植（KAH）和210例肺移植后肾移植（KAL）的预后。心脏移植后至肾移植的中位时间为100.3个月，肺移植后为90.2个月。大多数患者的肾衰竭归因于钙调神经磷酸酶抑制剂毒性。使用匹配对照（MC）将预后与原发性肾移植受者进行比较，以考虑供体、受体和移植物特征。尽管5年肾移植存活率低于原发性肾移植受者（KAH为61%，MC为73.8%，p<0.001；KAL为62.6%，MC为82.9%，p<0.001），但死亡 censored移植物存活率相当（KAH为84.9%，MC为88.2%，p = 0.1；KAL为87.6%，MC为91.8%，p = 0.6）。此外，与透析相比，肾移植使KAH受者的死亡风险降低了43%，使KAL受者的死亡风险降低了54%。我们的研究结果表明，肾移植在KAH和KAL受者中功能良好并提供生存益处，但受这些受者总体预期寿命的限制，肾移植的寿命有限，这可能有助于为该人群的临床决策和分配提供参考。
