Division of Transplant Surgery, Department of Surgery, University of Pennsylvania, Philadelphia, PA, USA.
Transplantation. 2010 Feb 27;89(4):427-33. doi: 10.1097/TP.0b013e3181c42248.
Chronic kidney disease among prior heart transplant recipients is a growing problem that is likely to place an increased demand on a limited supply of kidney allografts. Allocation of the limited resource of kidneys for transplantation requires consideration of the demands of fair distribution and optimizing patient and graft survival. The aim of this study was to compare the kidney transplant outcomes among recipients of kidney after prior heart transplantation (KAH, n=456) with kidney transplantation in other clinical settings.
A retrospective cohort study using United Network for Organ Sharing registry data (1995-2008) was performed comparing renal allograft survival among KAH recipients with patients who underwent simultaneous kidney-heart transplant (SKH, n=252), primary kidney transplant alone (KA1, n=112,882), or repeat kidney transplant alone (KA2, n=14,070).
The annual number of KAH recipients more than quadrupled during the study period from 24 in 1995 to 99 in 2008. In a multivariable analysis using Cox regression, allograft survival among KAH recipients was not different from SKH (P=0.16, hazards ratio [HR]=0.79, confidence interval [CI]=0.57-1.10), and KA2 (P=0.11, HR=0.86, CI=0.72-1.04), but it was inferior to KA1 (P<0.001, HR=0.66, CI=0.55-0.80). Patient death accounted for 75.2% of KAH kidney loss. Kidney quality as measured by living or deceased donors (P=0.62) and standard criteria or extended criteria (P=0.87) was not associated with survival; however, there was a trend toward improved survival (P=0.08) among recipients of a preemptive transplant.
Kidney graft survival among prior heart transplant recipients is inferior to KA1 but similar to other clinical scenarios. Preemptive transplantation with an extended criteria or living donor kidney should be encouraged.
在先前接受过心脏移植的患者中，慢性肾病是一个日益严重的问题，这可能会增加对有限的肾脏供体的需求。分配肾脏这一有限资源进行移植需要考虑公平分配的需求，并优化患者和移植物的存活率。本研究的目的是比较先前心脏移植后接受肾脏移植（KAH，n=456）与其他临床情况下接受肾脏移植的患者的肾脏移植结局。
使用美国器官共享网络（United Network for Organ Sharing）登记数据（1995-2008 年）进行回顾性队列研究，比较 KAH 受者的肾移植存活率与同时接受肾-心移植（SKH，n=252）、单纯初次肾移植（KA1，n=112882）或单纯重复肾移植（KA2，n=14070）的患者。
在研究期间，KAH 受者的年例数增加了四倍多，从 1995 年的 24 例增加到 2008 年的 99 例。在使用 Cox 回归的多变量分析中，KAH 受者的移植物存活率与 SKH（P=0.16，风险比[HR]=0.79，置信区间[CI]=0.57-1.10）和 KA2（P=0.11，HR=0.86，CI=0.72-1.04）无差异，但低于 KA1（P<0.001，HR=0.66，CI=0.55-0.80）。患者死亡占 KAH 肾脏丢失的 75.2%。肾脏质量（以活体或已故供体衡量，P=0.62）和标准标准或扩展标准（P=0.87）与存活率无关；然而，接受抢先移植的患者的存活率有改善趋势（P=0.08）。
先前接受过心脏移植的患者的肾脏移植物存活率低于 KA1，但与其他临床情况相似。应鼓励对扩展标准或活体供体肾脏进行抢先移植。
