A2 ABO 不相容肾移植的未充分利用。
Underutilization of A2 ABO incompatible kidney transplantation.
机构信息
Division of Transplant Surgery, Department of Surgery, Hospital of University of Pennsylvania, Philadelphia, PA 19104, USA.
出版信息
Clin Transplant. 2012 May-Jun;26(3):489-94. doi: 10.1111/j.1399-0012.2011.01543.x. Epub 2011 Oct 27.
BACKGROUND
ABO compatibility creates a disadvantage for O and B renal allograft candidates. A2 ABO incompatible transplant may decrease waiting times and generate equivalent graft survival to an ABO compatible transplant.
METHODS
Death-censored graft survival was compared between A recipients and O, B, and AB recipients of an A2 allograft with multivariate Cox regression models utilizing data from the United Network of Organ Sharing (UNOS) between 1997 and 2007.
RESULTS
Eighty-five percent of A2 kidneys were transplanted into ABO compatible recipients vs. 15% into ABO incompatible recipients. Rates of A2 incompatible kidney transplants did not increase over the study period (14.8% to 14.6%). Mean wait time for A2→O kidneys was 337 vs. 684 d for O→O and for A2→B kidneys, 542 vs. 734 d for B→B. Adjusted relative risk of graft loss at five-yr was similar between O, B, and AB recipients compared to A recipients of an A2 allograft, corresponding to a five-yr graft survival of 84%, 86.2%, 86.1%, and 86.1%, respectively.
CONCLUSION
A2 incompatible kidney transplantation is underutilized. Graft outcomes are similar among A2 compatible and incompatible recipients. Shorter waiting time and improved access might be achieved if A2 kidneys are considered in all blood groups.
背景
ABO 相容性对 O 和 B 肾移植候选者不利。A2ABO 不相容移植可能会缩短等待时间，并产生与 ABO 相容移植相当的移植物存活率。
方法
利用 1997 年至 2007 年美国器官共享网络（UNOS）的数据，通过多变量 Cox 回归模型比较 A 受体与 O、B 和 AB 受体接受 A2 同种异体移植物的死亡相关移植物存活率。
结果
85%的 A2 肾脏被移植到 ABO 相容的受者中，而 15%被移植到 ABO 不相容的受者中。在研究期间，A2 不相容肾脏移植的比例并未增加（从 14.8%到 14.6%）。A2→O 肾脏的平均等待时间为 337 天，而 O→O 的平均等待时间为 684 天；A2→B 肾脏的平均等待时间为 542 天，而 B→B 的平均等待时间为 734 天。与 A 受体接受 A2 同种异体移植物相比，O、B 和 AB 受体在五年时移植物丢失的调整相对风险相似，相应的五年移植物存活率分别为 84%、86.2%、86.1%和 86.1%。
结论
A2 不相容肾脏移植的应用不足。在 A2 相容和不相容受者中，移植物的结果相似。如果考虑所有血型的 A2 肾脏，可能会缩短等待时间并改善获得途径。
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