Division of Transplantation, The Rogosin Institute, New York, NY, USA.
Nephrol Dial Transplant. 2011 Jan;26(1):317-24. doi: 10.1093/ndt/gfq415. Epub 2010 Jul 23.
Despite marked improvement in short-term renal allograft survival rates (GSR) in recent years, improvement in long-term GSR remained elusive.
We analysed the kidney transplant experience at our centre accrued over four decades to evaluate how short-term and long-term GSR had changed and to identify risk factors affecting graft survival. The study included 1476 adult recipients of a deceased-donor kidney transplant who were transplanted between 1963 and 2006 and who had received one of five distinct immunosuppressive protocols.
Five-year actual GSR steadily improved over the years as immunosuppressive therapy evolved (22-86%, P < 0.001) in spite of an increasing trend in the transplantation of higher-risk donor-recipient pairings. For those whose grafts functioned for the first year, subsequent 4-year GSR (5-year conditional GSR) also improved significantly (63-92%, P < 0.001). Acute rejection and delayed graft function (DGF) were the most significant risk factors for actual graft survival, while acute rejection was the only significant risk factor for conditional GSR. Use of kidneys from expanded-criteria donors (ECD) was not a risk factor, compared to the use of standard-criteria donor kidneys for either 5-year actual or conditional GSR. There was an impressive decline in the incidence of acute rejection events (77.4-5.8%, P < 0.001). While the DGF rate had decreased, it still remained high (68.7-38.5%, P < 0.001).
We found a significant improvement in both short-term and long-term GSR of deceased-donor kidney transplants over the last four decades. These improvements are most likely related to the decreased incidence of acute rejection episodes. Minimizing acute rejection events and preventing DGF could result in further improvement in the GSR. Our experience in the judicious use of ECD kidneys suggests that this source of kidneys could be expanded further.
尽管近年来短期肾移植存活率（GSR）显著提高，但长期 GSR 的改善仍难以实现。
我们分析了我们中心在过去四十年中积累的肾移植经验，以评估短期和长期 GSR 的变化，并确定影响移植物存活的风险因素。该研究包括 1963 年至 2006 年间接受过 5 种不同免疫抑制方案的 1476 名成年死者供体肾移植受者。
尽管移植高风险供体-受者配对的趋势增加，但随着免疫抑制治疗的发展，5 年实际 GSR 多年来稳步提高（22-86%，P<0.001）。对于那些在第一年移植后移植物功能正常的患者，随后 4 年的 GSR（5 年条件 GSR）也显著提高（63-92%，P<0.001）。急性排斥反应和延迟移植物功能（DGF）是实际移植物存活的最重要风险因素，而急性排斥反应是条件 GSR 的唯一显著风险因素。与使用标准标准供体肾脏相比，使用扩展标准供体（ECD）的肾脏不是 5 年实际或条件 GSR 的风险因素。急性排斥反应事件的发生率显著下降（77.4-5.8%，P<0.001）。尽管 DGF 率有所下降，但仍很高（68.7-38.5%，P<0.001）。
我们发现过去四十年中，死者供体肾移植的短期和长期 GSR 均有显著提高。这些改进很可能与急性排斥反应事件发生率的降低有关。减少急性排斥反应事件和预防 DGF 可能会进一步提高 GSR。我们在明智使用 ECD 肾脏方面的经验表明，这种肾脏来源可以进一步扩大。
