美国与西班牙的肾移植长期预后比较。
Comparison of the long-term outcomes of kidney transplantation: USA versus Spain.
机构信息
Department of Medicine, University of Michigan, Ann Arbor, MI, USA.
出版信息
Nephrol Dial Transplant. 2013 Jan;28(1):213-20. doi: 10.1093/ndt/gfs287. Epub 2012 Jul 2.
BACKGROUND
The long-term outcomes of kidney transplantation are suboptimal because many patients lose their allografts or experience premature death. Cross-country comparisons of long-term outcomes of kidney transplantation may provide insight into factors contributing to premature graft failure and death. We evaluated the rates of late graft failure and death among US and Spanish kidney recipients.
METHODS
This is a cohort study of US (n = 9609) and Spanish (n = 3808) patients who received a deceased donor kidney transplant in 1990, 1994, 1998 or 2002 and had a functioning allograft 1 year after transplantation with follow-up through September 2006. Ten-year overall and death-censored graft survival and 10-year overall recipient survival and death with graft function (DWGF) were estimated with multivariate Cox models.
RESULTS
Among recipients alive with graft function 1 year after transplant, the 10-year graft survival was 71.3% for Spanish and 53.4% for US recipients (P < 0.001). The 10-year, death-censored graft survival was 75.6 and 76.0% for Spanish and US recipients, respectively (P = 0.73). The 10-year recipient survival was 86.2% for Spanish and 67.4% for US recipients (P < 0.001). In recipients with diabetes as the cause of ESRD, the adjusted DWGF rates at 10 years were 23.9 and 53.8 per 1000 person-years for Spanish and US recipients, respectively (P < 0.001). Among recipients whose cause of ESRD was not diabetes mellitus, the adjusted 10-year DWGF rates were 11.0 and 25.4 per 1000 person-years for Spanish and US recipients, respectively.
CONCLUSIONS
US kidney transplant recipients had more than twice the long-term hazard of DWGF compared with Spanish kidney transplant recipients and similar levels of death-censored graft function. Pre-transplant medical care, comorbidities, such as cardiovascular disease, and their management in each country's health system are possible explanations for the differences between the two countries.
背景
由于许多患者失去移植物或过早死亡，肾移植的长期效果并不理想。对肾移植长期效果的跨国比较可以深入了解导致移植物早期失功和死亡的因素。我们评估了美国和西班牙肾移植受者的晚期移植物失功和死亡发生率。
方法
这是一项在美国（n=9609）和西班牙（n=3808）接受 1990、1994、1998 或 2002 年已故供者肾移植且移植后 1 年有功能移植物的患者队列研究，随访至 2006 年 9 月。采用多变量 Cox 模型估计 10 年总生存率和无死亡事件的移植物生存率以及 10 年总受者生存率和带移植物功能的死亡（DWGF）。
结果
在移植后 1 年有功能移植物且存活的受者中，西班牙和美国受者的 10 年移植物存活率分别为 71.3%和 53.4%（P<0.001）。西班牙和美国受者的 10 年无死亡事件的移植物存活率分别为 75.6%和 76.0%（P=0.73）。西班牙和美国受者的 10 年受者生存率分别为 86.2%和 67.4%（P<0.001）。在以糖尿病为 ESRD 病因的受者中，西班牙和美国受者的调整后 10 年 DWGF 发生率分别为 23.9 和 53.8/1000 人年（P<0.001）。在 ESRD 病因非糖尿病的受者中，西班牙和美国受者的调整后 10 年 DWGF 发生率分别为 11.0 和 25.4/1000 人年。
结论
与西班牙肾移植受者相比，美国肾移植受者发生 DWGF 的长期风险高两倍以上，而无死亡事件的移植物功能相似。两国之间的差异可能与两国的移植前医疗保健、心血管疾病等合并症以及各自国家卫生系统中的管理有关。
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