Santori G, Fontana I, Bertocchi M, Gasloli G, Magoni Rossi A, Tagliamacco A, Barocci S, Nocera A, Valente U
Department of Transplantation, San Martino University Hospital, Genoa, Italy.
Transplant Proc. 2010 May;42(4):1098-103. doi: 10.1016/j.transproceed.2010.03.037.
A useful approach to reduce the number of discarded marginal kidneys and to increase the nephron mass is double kidney transplantation (DKT). In this study, we retrospectively evaluated the potential predictors for patient and graft survival in a single-center series of 59 DKT procedures performed between April 21, 1999, and September 21, 2008. The kidney recipients of mean age 63.27 +/- 5.17 years included 16 women (27%) and 43 men (73%). The donors of mean age 69.54 +/- 7.48 years included 32 women (54%) and 27 men (46%). The mean posttransplant dialysis time was 2.37 +/- 3.61 days. The mean hospitalization was 20.12 +/- 13.65 days. Average serum creatinine (SCr) at discharge was 1.5 +/- 0.59 mg/dL. In view of the limited numbers of recipient deaths (n = 4) and graft losses (n = 8) that occurred in our series, the proportional hazards assumption for each Cox regression model with P < .05 was tested by using correlation coefficients between transformed survival times and scaled Schoenfeld residuals, and checked with smoothed plots of Schoenfeld residuals. For patient survival, the variables that reached statistical significance were donor SCr (P = .007), donor creatinine cleararance (P = .023), and recipient age (P = .047). Each significant model passed the Schoenfeld test. By entering these variables into a multivariate Cox model for patient survival, no further significance was observed. In the univariate Cox models performed for graft survival, statistical significance was noted for donor SCr (P = .027), SCr 3 months post-DKT (P = .043), and SCr 6 months post-DKT (P = .017). All significant univariate models for graft survival passed the Schoenfeld test. A final multivariate model retained SCr at 6 months (beta = 1.746, P = .042) and donor SCr (beta = .767, P = .090). In our analysis, SCr at 6 months seemed to emerge from both univariate and multivariate Cox models as a potential predictor of graft survival among DKT. Multicenter studies with larger recipient populations and more graft losses should be performed to confirm our findings.
减少废弃边缘肾脏数量并增加肾单位数量的一种有效方法是双肾移植（DKT）。在本研究中，我们回顾性评估了1999年4月21日至2008年9月21日在单中心进行的59例DKT手术中患者和移植物存活的潜在预测因素。肾脏受者的平均年龄为63.27±5.17岁，其中包括16名女性（27%）和43名男性（73%）。供者的平均年龄为69.54±7.48岁，其中包括32名女性（54%）和27名男性（46%）。移植后平均透析时间为2.37±3.61天。平均住院时间为20.12±13.65天。出院时平均血清肌酐（SCr）为1.5±0.59mg/dL。鉴于我们系列中发生的受者死亡（n = 4）和移植物丢失（n = 8）数量有限，使用转换后的生存时间与标准化Schoenfeld残差之间的相关系数对每个P <.05的Cox回归模型的比例风险假设进行了检验，并用Schoenfeld残差的平滑图进行了检查。对于患者生存，达到统计学显著性的变量是供者SCr（P = .007）、供者肌酐清除率（P = .023）和受者年龄（P = .047）。每个显著模型均通过了Schoenfeld检验。将这些变量纳入患者生存的多变量Cox模型后，未观察到进一步的显著性。在为移植物存活进行的单变量Cox模型中，供者SCr（P = .027）、DKT后3个月的SCr（P = .043）和DKT后6个月的SCr（P = .017）具有统计学显著性。所有移植物存活的显著单变量模型均通过了Schoenfeld检验。最终的多变量模型保留了6个月时的SCr（β = 1.746，P = .042）和供者SCr（β = .767，P = .090）。在我们的分析中，6个月时的SCr似乎在单变量和多变量Cox模型中均作为DKT中移植物存活的潜在预测因素出现。应进行更大受者群体和更多移植物丢失的多中心研究以证实我们的发现。
