供受者性别和大小不匹配会影响肾移植后的移植物成功。
Donor-recipient gender and size mismatch affects graft success after kidney transplantation.
机构信息
Department of Surgery, Tulane University School of Medicine, New Orleans, LA 70112-2669, USA.
出版信息
J Am Coll Surg. 2010 May;210(5):718-725.e1, 725-6. doi: 10.1016/j.jamcollsurg.2009.12.032.
BACKGROUND
Female recipients of male kidneys have an inferior graft survival, and patients receiving larger kidneys relative to their body size may have a graft survival advantage. Thus, graft survival may be affected by both gender and kidney size mismatches. The objective of this study was to analyze the possible confounding effect of body mass mismatch (body mass as proxy for kidney size) between female recipients of male donor kidneys.
STUDY DESIGN
A total of 668 kidney transplantations between 1996 and 2005 at our center were studied retrospectively. Graft and patient survival were determined by Kaplan-Meier estimation. Multivariate Cox proportional analyses were performed to determine the hazards of graft loss.
RESULTS
There were 146 female recipients of male kidneys. Compared with all other gender combinations, this group had the lowest unadjusted graft survival (86%, 79%, and 78% vs 92%, 88%, and 86% at 1, 2, and 3 years, respectively; log-rank p = 0.01). Donor body mass index (BMI) correlated with donor kidney size (p < 0.001). Male kidneys were a risk factor of graft loss for female recipients (hazard ratio [HR] 3.45, 95% CI 1.40 to 8.51, p = 0.01), but male donors with a larger BMI relative to female recipients' significantly reduced the risk (HR 0.19, 95% CI 0.05 to 0.67, p = 0.01).
CONCLUSIONS
The inferior graft survival for female recipients of male donor kidneys is mitigated by male donors with a larger BMI.
背景
女性接受男性供肾者的移植物存活率较低，而接受与自身体型相比更大的肾脏的患者可能具有移植物存活率优势。因此，移植物存活率可能会受到性别和肾脏大小不匹配的影响。本研究的目的是分析女性接受男性供体肾脏的患者中，体重不匹配（体重作为肾脏大小的替代指标）对移植物存活率的可能混杂影响。
研究设计
回顾性分析了我们中心 1996 年至 2005 年间进行的 668 例肾移植。通过 Kaplan-Meier 估计法确定移植物和患者的存活率。采用多变量 Cox 比例风险分析来确定移植物丢失的风险。
结果
共有 146 例女性接受了男性供肾。与所有其他性别组合相比，该组的未调整移植物存活率最低（分别为 1、2 和 3 年的 86%、79%和 78%；log-rank p = 0.01）。供体体重指数（BMI）与供体肾脏大小相关（p < 0.001）。男性供肾是女性受者移植物丢失的危险因素（风险比[HR] 3.45，95%CI 1.40 至 8.51，p = 0.01），但相对于女性受者体重指数较大的男性供者显著降低了这种风险（HR 0.19，95%CI 0.05 至 0.67，p = 0.01）。
结论
女性接受男性供肾者的移植物存活率较低，而男性供者体重指数较大时可以减轻这种影响。
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