Division of Nephrology, Hypertension and Renal Transplantation, Department of Medicine, University of Florida, FL, USA.
Am J Transplant. 2011 Jun;11(6):1226-35. doi: 10.1111/j.1600-6143.2011.03539.x. Epub 2011 May 12.
Organ survival in the short-term period post-transplant has improved dramatically over the past few decades. Whether this has translated to a long-term survival benefit remains unclear. This study quantifies the progression of nonrenal solid organ transplant outcomes from 1989 to 2009 in liver, lung, heart, intestine and pancreas transplants. Long-term graft survival was analyzed using data on adult solid organ transplant recipients from the UNOS/SRTR database and is reported as organ half-life and yearly attrition rates. Liver, lung, heart, intestine and pancreas half-lives have improved from 5.8 to 8.5, 1.7 to 5.2, 8.8 to 11, 2.1 to 3.6 and 10.5 to 16.7 years, respectively. Long-term attrition rates have not shown the same consistent improvement, with the yearly attrition rate 5-10 years post-transplant for liver, lung, heart and pancreas changing from 4.7 to 4.3, 10.9 to 10.1, 6.4 to 5.1 and 3.3 to 4.2, respectively. Attrition rates for intestine and pancreas transplantation alone display more variability due to smaller sample size but exhibit similar trends of improved first-year attrition and relatively stagnant long-term attrition rates. With first-year survival and attrition rates almost at a pinnacle, further progress in long-term survival will come from targeting endpoints beyond first-year rejection and survival rates.
在过去的几十年中，器官移植后短期的器官存活率有了显著提高。但这是否转化为长期的生存获益尚不清楚。本研究量化了 1989 年至 2009 年期间肝、肺、心脏、肠和胰腺移植中非肾脏实体器官移植结局的进展情况。使用 UNOS/SRTR 数据库中成人实体器官移植受者的数据来分析长期移植物存活率，并以器官半衰期和年损耗率来报告。肝、肺、心脏、肠和胰腺的半衰期分别从 5.8 年提高到 8.5 年、1.7 年提高到 5.2 年、8.8 年提高到 11 年、2.1 年提高到 3.6 年和 10.5 年提高到 16.7 年。长期损耗率并没有显示出同样的持续改善，肝、肺、心脏和胰腺移植后 5-10 年的年损耗率从 4.7%降至 4.3%、10.9%降至 10.1%、6.4%降至 5.1%和 3.3%降至 4.2%。肠和胰腺移植的损耗率由于样本量较小而显示出更大的变异性，但显示出相似的改善第一年损耗和相对停滞的长期损耗率的趋势。随着第一年的生存率和损耗率几乎达到顶峰，进一步提高长期生存率将需要针对第一年排斥反应和生存率以外的终点。
