Vathsala Anantharaman
Division of Nephrology, Department of Medicine, National University Health System, Singapore.
Clin Transpl. 2010:149-60.
The 5-year and 10-year graft survivals for 186 deceased donor (DD) transplants performed at National University Health System (NUHS) were 79.9% and 58.4% respectively. 5-year and 10-year patient survivals for DD transplants performed at NUHS were 94.2% and 83.4%. The 5-year and 10-year graft survivals for 128 living donor (LD) transplants performed at NUHS were 90.2% and 72% respectively. 5-year and 10-year patient survivals for DD transplants performed at NUHS were 98.6% and 95.1%. The projected graft half lives were 14.6 and 20.6 years for DD and LD transplants respectively. These results compare favorably with the 10-year survival rates of 40% and 58% for DD and LD grafts reported by the United States Renal Data System (USRDS) in 2010. The younger age and the lower prevalence of diabetes and HLAmismatch in the DD and LD transplant study populations, in comparison to the USRDS population and perhaps better access and compliance to maintenance immunosuppression, could have contributed to these excellent outcomes. The 5-year and 10-year graft survivals for 162 transplants receiving what were likely deceased donor kidneys from China were 89.2% and 69.2% respectively. Although these survivals were apparently better than that for DD performed at NUHS, the advantage for China Tx disappeared when DD with primary non function or vascular thrombosis were excluded from analysis. The 5-year and 10-year patient survivals for 30 transplants receiving live non-related transplants from India were 82.3% and 60.1%. Both groups were considered to have received commercial transplants based on various aspects of history from the patients. Among those receiving China_Tx or India Tx, there were a disproportionate number of males and Chinese; and a significant proportion underwent pre-emptive transplant or transplant after only a short period of dialysis. Prevalence of post-transplant hepatitis B was significantly higher among China_Tx than their DD counterparts (7.7% vs. 1.2%, P = 0.005); likewise, post transplant hepatitis C was significantly higher for India_Tx than their LD counterparts (23.1% vs. 3.4%, P = 0.003). These results suggest that commercialization in transplant, results in inequities to access to transplantation and is associated with compromise in screening for infections among potential donors or in observing safety precautions during dialysis.
在新加坡国立大学医疗系统（NUHS）进行的186例 deceased donor（DD，死亡供体）移植手术中，5年和10年的移植物存活率分别为79.9%和58.4%。在NUHS进行的DD移植手术的5年和10年患者存活率分别为94.2%和83.4%。在NUHS进行的128例 living donor（LD，活体供体）移植手术中，5年和10年的移植物存活率分别为90.2%和72%。在NUHS进行的DD移植手术的5年和10年患者存活率分别为98.6%和95.1%。DD和LD移植的预计移植物半衰期分别为14.6年和20.6年。这些结果与美国肾脏数据系统（USRDS）在2010年报告的DD和LD移植物10年存活率40%和58%相比更具优势。与USRDS人群相比，DD和LD移植研究人群年龄更小，糖尿病患病率和HLA错配率更低，并且可能在维持免疫抑制方面有更好的可及性和依从性，这些因素可能促成了这些优异的结果。在162例接受可能来自中国的 deceased donor 肾脏的移植手术中，5年和10年的移植物存活率分别为89.2%和69.2%。尽管这些存活率明显高于在NUHS进行的DD移植，但当排除原发性无功能或血管血栓形成的DD后，中国移植的优势消失。在30例接受来自印度的活体非亲属移植手术中，5年和10年的患者存活率分别为82.3%和60.1%。基于患者病史的各个方面，这两组都被认为接受了商业移植。在接受中国移植或印度移植的患者中，男性和中国人的比例过高；并且很大一部分患者进行了抢先移植或仅在短时间透析后就进行了移植。中国移植患者中移植后乙型肝炎的患病率显著高于其DD对应组（7.7%对1.2%，P = 0.005）；同样，印度移植患者移植后丙型肝炎的患病率显著高于其LD对应组（23.1%对3.4%，P = 0.003）。这些结果表明，移植商业化导致了移植可及性的不平等，并与潜在供体感染筛查不足或透析期间未遵守安全预防措施有关。
