Department of Clinical Research, Renal Consultants of Houston, 2412 Westgate Street, Houston, TX, USA.
J Am Soc Nephrol. 2010 Feb;21(2):374-80. doi: 10.1681/ASN.2009050480. Epub 2009 Oct 29.
There is a growing number of patients returning to dialysis after a failed kidney transplant, and there is increasing evidence of higher mortality among this population. Whether removal of the failed renal allograft affects survival while receiving long-term dialysis is not well understood. We identified all adults who received a kidney transplant and returned to long-term dialysis after renal allograft failure between January 1994 and December 2004 from the US Renal Data System. Among 10,951 transplant recipients who returned to long-term dialysis, 3451 (31.5%) received an allograft nephrectomy during follow-up. Overall, 34.6% of these patients died during follow-up. Receiving an allograft nephrectomy associated with a 32% lower adjusted relative risk for all-cause death (adjusted hazard ratio 0.68; 95% confidence interval 0.63 to 0.74) after adjustment for sociodemographic characteristics, comorbidity burden, donor characteristics, interim clinical conditions associated with receiving allograft nephrectomy, and propensity to receive an allograft nephrectomy. In conclusion, within a large, nationally representative sample of high-risk patients returning to long-term dialysis after failed kidney transplant, receipt of allograft nephrectomy independently associated with improved survival.
越来越多的患者在肾移植失败后返回透析，并且越来越多的证据表明该人群的死亡率更高。在接受长期透析的过程中，移除失败的肾移植是否会影响生存，目前尚不清楚。我们从美国肾脏数据系统中确定了所有在 1994 年 1 月至 2004 年 12 月期间因肾移植失败而返回长期透析的成年人。在返回长期透析的 10951 名移植受者中，有 3451 名（31.5%）在随访期间接受了移植肾切除术。总的来说，这些患者中有 34.6%在随访期间死亡。在调整了社会人口统计学特征、合并症负担、供体特征、与接受移植肾切除术相关的中期临床情况以及接受移植肾切除术的倾向后，接受移植肾切除术与全因死亡的调整相对风险降低 32%相关（调整后的危险比为 0.68；95%置信区间为 0.63 至 0.74）。总之，在一个来自高风险患者的大型、全国代表性样本中，这些患者在肾移植失败后返回长期透析，接受移植肾切除术与生存率的提高独立相关。
