Department of Surgery, Division of Transplantation, University of Pennsylvania, Philadelphia, PA, USA.
Am J Transplant. 2010 Nov;10(11):2502-11. doi: 10.1111/j.1600-6143.2010.03292.x.
The disparity between the number of patients waiting for kidney transplantation and the limited supply of kidney allografts has renewed interest in the benefit from kidney transplantation experienced by different groups. This study evaluated kidney transplant survival benefit in prior nonrenal transplant recipients (kidney after liver, KALi; lung, KALu; heart, KAH) compared to primary isolated (KA1) or repeat isolated kidney (KA2) transplant. Multivariable Cox regression models were fit using UNOS data for patients wait listed and transplanted from 1995 to 2008. Compared to KA1, the risk of death on the wait list was lower for KA2 (p < 0.001;HR = 0.84;CI = 0.81-0.88), but substantially higher for KALu (p < 0.001; HR = 3.80;CI = 3.08-4.69), KAH (p < 0.001; HR = 1.92; CI = 1.66-2.22), and KALi (p < 0.001; HR = 2.69; CI = 2.46-2.95). Following kidney transplant, patient survival was greatest for KA1, similar among KA2, KALi, KAH, and inferior for KALu. Compared to the entire wait list, renal transplantation was associated with a survival benefit among all groups except KALu (p = 0.017; HR = 1.61; CI = 1.09-2.38), where posttransplant survival was inferior to the wait list population. Recipients of KA1 kidney transplantation have the greatest posttransplant survival and compared to the overall kidney wait list, the greatest survival benefit.
在等待肾移植的患者数量与肾移植供体的有限供应之间存在差距的情况下，人们对不同群体接受肾移植的获益重新产生了兴趣。本研究评估了先前接受过非肾移植（肝后肾，KALi；肺后肾，KALu；心后肾，KAH）的患者与初次接受孤立肾移植（KA1）或重复孤立肾移植（KA2）的患者相比，肾移植存活率的获益。使用 UNOS 数据，对 1995 年至 2008 年期间登记和接受移植的患者进行多变量 Cox 回归模型拟合。与 KA1 相比，KA2 患者在等待名单上的死亡风险较低（p < 0.001；HR = 0.84；CI = 0.81-0.88），但 KALu（p < 0.001；HR = 3.80；CI = 3.08-4.69）、KAH（p < 0.001；HR = 1.92；CI = 1.66-2.22）和 KALi（p < 0.001；HR = 2.69；CI = 2.46-2.95）的风险要高得多。接受肾移植后，KA1 患者的生存率最高，KA2、KALi、KAH 之间的生存率相似，而 KALu 患者的生存率较低。与整个等待名单相比，肾移植与除 KALu 之外的所有组的生存率均呈正相关（p = 0.017；HR = 1.61；CI = 1.09-2.38），其中移植后生存率低于等待名单人群。KA1 肾移植受者的移植后生存率最高，与整个肾等待名单相比，生存获益最大。
