Salvadori M, Bertoni E, Rosso G, Larti A, Rosati A
Renal Unit, Careggi University Hospital, Florence, Italy.
Transplant Proc. 2009 May;41(4):1084-6. doi: 10.1016/j.transproceed.2009.03.031.
Preemptive kidney transplantation is performed before the initiation of chronic dialysis. Preemptive transplantation is the best treatment modality for patients reaching end-stage renal disease. The Tuscany region has experienced, in the last years, a marked increase in donation rate. Starting from 2006, the first Italian cadaveric preemptive transplant program was activated. The aim of our study was to investigate the characteristics and preliminary results of this program. Among 163 patients entered on to the waiting list for renal transplantation from October 2006 to October 2008, 120 (73.6%) were on dialysis for 21.3 +/- 17.8 months, whereas 43 patients (26.4%) had not yet been on dialysis (preemptive). Eighty two patients (50.3%) resided in Tuscany and 81 (49.7) outside Tuscany; 36.6% of Tuscany patients and 16% of extraregional patients (P = .003) were listed as preemptive. Fifty-eight of 163 (35.6%) patients were transplanted during the period after a mean waiting time of 10.3 +/- 6.4 months. The estimated overall man waiting time was 17.5 months (confidence interval (CI) = 15.8-19.2). Upon Cox multivariate analysis, the probability of transplantation was similar for preemptive and dialysed patients (relative risk [RR] 1.02, P = NS). According to local allocation policy, only residents of Tuscany showed a significant advantage in both groups (RR = 0.43, CI = 0.24-0.75, P = .003). Two-year graft and patients survivals were similar, but delayed graft function was lower in the preemptive group (13% vs 42%, P = .007). The 1-year serum creatinine was 1.56 +/- 0.43 in the preemptive group and 1.68 +/- 0.92 in the dialysis group (P = NS). No differences were observed concerning rejection rate. The preemptive listing rate for cadaveric renal transplantation was more than 35% for Tuscany patients.
预先肾移植在开始慢性透析之前进行。预先移植是终末期肾病患者的最佳治疗方式。在过去几年中，托斯卡纳地区的捐赠率显著上升。从2006年开始，启动了首个意大利尸体预先移植项目。我们研究的目的是调查该项目的特点和初步结果。在2006年10月至2008年10月进入肾移植等待名单的163例患者中，120例（73.6%）已透析21.3±17.8个月，而43例患者（26.4%）尚未透析（预先移植）。82例患者（50.3%）居住在托斯卡纳，81例（49.7%）居住在托斯卡纳以外地区；托斯卡纳患者中有36.6%被列为预先移植，而地区外患者中有16%被列为预先移植（P = 0.003）。163例患者中有58例（35.6%）在平均等待10.3±6.4个月后在此期间接受了移植。估计总体平均等待时间为17.5个月（置信区间[CI]=15.8 - 19.2）。经Cox多变量分析，预先移植患者和已透析患者的移植概率相似（相对风险[RR]1.02，P = 无显著性差异）。根据当地分配政策，只有托斯卡纳地区的居民在两组中均显示出显著优势（RR = 0.43，CI = 0.24 - 0.75），P = 0.003）。两年的移植物和患者生存率相似，但预先移植组的移植肾功能延迟发生率较低（13%对42%，P = 0.007）。预先移植组1年血清肌酐为1.56±0.43，透析组为1.68±0.92（P = 无显著性差异）。在排斥率方面未观察到差异。托斯卡纳地区患者尸体肾移植的预先登记率超过35%。
