Hardy B E, Shah T, Cicciarelli J, Lemley K V, Hutchinson I V, Cho Y W
Urology, Children Hospital Los Angeles, California 90027, USA.
Transplant Proc. 2009 Jun;41(5):1533-5. doi: 10.1016/j.transproceed.2009.01.102.
Specific pediatric allocation schemes can not only lead to minimization of waiting time, but also to better clinical outcomes for children with end-stage renal disease. The outcome of 4125 deceased donor kidney transplants (DDKT) aged 5-35 years were compared with those of 6456 living donor kidney transplants (LDKT) using univariate and multivariate Cox regression analyses. Unadjusted graft survival rates of DDKT were significantly lower than those of LDKT (hazards ratio [HR] = 1.53; P < .001). Chronic rejection was reported in 416 (10.1%) of 4125 in the DDKT group compared with 537 (8.3%) of 6456 in the LDKT group (P < .001). Among African American recipients, 67 (3.4%) grafts were lost due to noncompliance as a contributory cause of failure compared with 126 (1.5%) among other races (P < .001). A significantly lower incidence of noncompliance was observed in children (0.9%) compared with adolescents (2.2% in ages 10-14; P < .001) and high teens (2.0% in ages 15-20; P < .001). Multivariate analysis showed that adjusted graft survival rates of LDKT were superior to DDKT (HR = 1.22; P < .001) after adjusting for recipient race, recipient age, regraft status, and HLA mismatch. The differences of long-term graft survival rates between DDKT and LDKT have not been reduced (4% at 1 year, 10% at 3 years, and 12% at 5 years for unadjusted survival rates and 3% at 1 year, 6% at 3 years, and 9% at 5 years adjusted survival rates). In our analysis presented here the difference in graft survival between LDKT and DDKT has doubled compared with earlier analysis. Therefore, we recommend LDKT whenever possible as a first choice for pediatric transplant recipients.
特定的儿科分配方案不仅可以使等待时间最短化，还能为终末期肾病患儿带来更好的临床结局。采用单因素和多因素Cox回归分析，比较了4125例年龄在5至35岁的 deceased donor kidney transplants（DDKT， deceased donor kidney transplants 直译为“ deceased 供体肾移植”，在医学语境中通常指“ deceased 供者肾移植”）与6456例 living donor kidney transplants（LDKT， living donor kidney transplants 直译为“ living 供体肾移植”，在医学语境中通常指“ living 供者肾移植”）的结局。DDKT未调整的移植肾存活率显著低于LDKT（风险比[HR]=1.53；P<.001）。DDKT组4125例中有416例（10.1%）报告发生慢性排斥反应，而LDKT组6456例中有537例（8.3%）发生慢性排斥反应（P<.001）。在非裔美国受者中，67例（3.4%）移植肾因不依从作为失败的一个促成原因而丢失，而在其他种族中为126例（1.5%）（P<.001）。与青少年（10至14岁为2.2%；P<.001）和青少年后期（15至20岁为2.0%；P<.001）相比，儿童中不依从的发生率显著较低（0.9%）。多因素分析显示，在调整受者种族、受者年龄、再次移植状态和HLA错配后，LDKT调整后的移植肾存活率优于DDKT（HR=1.22；P<.001）。DDKT和LDKT之间长期移植肾存活率的差异并未缩小（未调整的存活率在1年时为4%，3年时为10%，5年时为12%；调整后的存活率在1年时为3%，3年时为6%，5年时为9%）。在我们此处给出的分析中，LDKT和DDKT之间移植肾存活率的差异与早期分析相比增加了一倍。因此，我们建议只要有可能，LDKT应作为儿科移植受者的首选。
