肾移植后与移植物丢失和患者存活相关的危险因素。

Risk factors associated with graft loss and patient survival after kidney transplantation.

作者信息

Harada K M, Mandia-Sampaio E L, de Sandes-Freitas T V, Felipe C R, Park S I, Pinheiro-Machado P G, Garcia R, Tedesco-Silva H, Medina-Pestana J O

机构信息

Division of Nephrology, Hospital do Rim e Hipertensão, Universidade Federal de São Paulo, São Paulo, Brazil.

出版信息

Transplant Proc. 2009 Nov;41(9):3667-70. doi: 10.1016/j.transproceed.2009.04.013.

DOI:10.1016/j.transproceed.2009.04.013

PMID:19917364

Abstract

OBJECTIVE

To evaluate the influence of traditional risk factors on major kidney transplantation outcome.

PATIENTS AND METHODS

Data from kidney transplantation procedures performed between 2003 and 2006 were retrospectively analyzed for the influence of traditional risk factors on transplantation outcome. Of 2364 transplants, 67% were from living donors, 27% were from donors who met standard criteria, and 6% were from donor who met expanded criteria. Two hundred thirty-nine procedures (10%) were performed in pediatric patients. Immunosuppression was selected on the basis of subgroup population.

RESULTS

At 1 year posttransplantation, cumulative freedom from a treated acute rejection episode (ARE) was 76.7%, with no difference between black vs nonblack recipients (75.0% vs 73.4%; P = .79). At 2 years, survival for patients (95.3% vs 88.3% vs 82.1%; P < .001) and grafts 92.3% vs 80.3% vs 70.9%; P < .001) was better in recipients of living donor grafts compared with donors who met standard or expanded criteria, respectively. Moreover, graft survival was poorer in black vs nonblack patients (83.6% vs 88.7%; P < .05) because of high mortality (13% vs 7%; P<.001). Risk factors associated with death included cadaveric donor organ (odds ratio [OR], 2.4) and black race (OR, 1.8), and risk factors associated with graft loss included cadaveric donor organ (OR, 2.1), extended-criteria criteria donor organ (OR, 2.0), delayed graft function (OR, 1.8), and any ARE (OR, 3.5). At 6 months posttransplantation, risk factors associated with death included cadaveric donor organ (OR, 2.5) or ARE (OR, 2.4), and risk factors associated with graft loss included cadaveric donor organ (OR, 2.0), extended-criteria donor organ (OR, 2.6), ARE (OR, 9.5), and impaired graft function (creatinine concentration >1.5 mg/dL; OR, 2.1).

CONCLUSION

Traditional risk factors are still associated with transplantation outcome. Poorer graft survival in black vs nonblack recipients was due to higher mortality rather than graft loss.

摘要

目的

评估传统风险因素对肾移植主要结局的影响。

患者与方法

回顾性分析2003年至2006年间肾移植手术的数据，以研究传统风险因素对移植结局的影响。在2364例移植手术中，67%的供体为活体，27%的供体符合标准标准，6%的供体符合扩大标准。239例手术（10%）为儿科患者。免疫抑制方案根据亚组人群进行选择。

结果

移植后1年，经治疗的急性排斥反应（ARE）累计缓解率为76.7%，黑种人与非黑种人受者之间无差异（75.0%对73.4%；P = 0.79）。2年时，活体供肾受者的患者生存率（95.3%对88.3%对82.1%；P < 0.001）和移植肾生存率（92.3%对80.3%对70.9%；P < 0.001）分别优于符合标准或扩大标准的供体受者。此外，由于高死亡率（13%对7%；P < 0.001），黑种人患者的移植肾生存率低于非黑种人患者（83.6%对88.7%；P < 0.05）。与死亡相关的风险因素包括尸体供肾器官（比值比[OR]，2.4）和黑人种族（OR，1.8），与移植肾丢失相关的风险因素包括尸体供肾器官（OR，2.1）、扩大标准供肾器官（OR，2.0）、移植肾功能延迟（OR，1.8）和任何ARE（OR，3.5）。移植后6个月，与死亡相关的风险因素包括尸体供肾器官（OR，2.5）或ARE（OR，2.4），与移植肾丢失相关的风险因素包括尸体供肾器官（OR，2.0）、扩大标准供肾器官（OR，2.6）、ARE（OR，9.5）和移植肾功能受损（肌酐浓度>1.5 mg/dL；OR，2.1）。