Department of Medicine and Pediatrics, Dalhousie Medical School, Halifax, Nova Scotia, Canada.
BMC Nephrol. 2011 Oct 7;12:54. doi: 10.1186/1471-2369-12-54.
There is a perception that kidney transplant recipients transferred from pediatric centers to adult care have an increased risk of graft loss. It is not clear whether young adults transplanted in adult centers also suffer from high graft loss rates.
We examined death censored graft survival in 3 cohorts of young patients transplanted at a single center. Pediatric (PED) patients transplanted at the pediatric center were compared to a cohort of young adults (YAD; age 18- < 25) and a cohort of adults (ADL; age 25-35).
In a multivariate Cox model for death-censored graft survival, PED survival was statistically similar to the YAD (HR 0.86, 95% CI 0.44, 1.7, p = 0.66), however the ADL cohort (HR 0.45, 95% CI 0.25, 0.82, p = 0.009) demonstrated better survival. Admitted non-adherence rates were not different among cohorts. Patients were transferred within a narrow age window (18.6 ± 1.0 age in years) but at a wide range of times from the date of transplantation (5.1 ± 3.5 years) and with a wide range of graft function (serum creatinine 182 ± 81 μmol/L).
The perception that pediatric transfers do poorly reflects advanced graft dysfunction in some at the time of transfer. The evidence also suggests that it is not the transfer of care that is the critical issue but rather recipients, somewhere between the ages of 11-14 and 25, are a unique and vulnerable cohort. Effective strategies to improve outcomes across this age group need to be identified and applied consistently.
有一种观点认为，从儿科中心转至成人护理的肾移植受者发生移植物丢失的风险增加。目前尚不清楚在成人中心接受移植的年轻成年人是否也存在较高的移植物丢失率。
我们在单个中心检查了 3 个年轻患者队列的死亡风险校正移植物存活率。将儿科（PED）中心接受移植的患者与年轻成人（YAD；年龄 18-<25 岁）队列和成年（ADL；年龄 25-35 岁）队列进行比较。
在死亡风险校正移植物存活率的多变量 Cox 模型中，PED 存活率在统计学上与 YAD 相似（HR 0.86，95%CI 0.44，1.7，p = 0.66），而 ADL 队列（HR 0.45，95%CI 0.25，0.82，p = 0.009）显示出更好的存活率。各队列的非遵医行为发生率无差异。患者的转科年龄窗口较窄（18.6 ± 1.0 岁），但从移植日期到转科的时间范围较宽（5.1 ± 3.5 年），且移植物功能范围较宽（血清肌酐 182 ± 81 μmol/L）。
儿科转科患者预后不良的看法反映了在转科时某些患者的移植物功能已经严重受损。这一证据还表明，关键问题不是护理的转移，而是 11-14 岁至 25 岁之间的受者是一个独特而脆弱的群体。需要确定并始终如一地应用改善这一年龄段患者结局的有效策略。
