Bisigniano L, López-Rivera A, Tagliafichi V, Fernández V, Soratti C
Scientific-Technical Office at INCUCAI (National Institute of Procurement and transplantation in Argentina-Ministry of Health), Buenos Aires, Argentina.
Transplant Proc. 2012 Sep;44(7):2235-8. doi: 10.1016/j.transproceed.2012.07.127.
Thanks to advances in surgical techniques and immune system suppression, the mortality rate in children with end-stage renal disease (ESRD) has dramatically declined. Kidney transplantation has become the primary method to treat ESRD in the pediatric population.
Information was obtained from SINTRA (National Information System of Orrgan Procurement and transplantation in Argentina) for the period 1998-2009. We used the Kaplan-Meier curve, survival was measured at 30 days, 1, 5, and 10 years. The Cox regression variables taken for patient and graft survival were gender and age of both donor and recipient, ischemia time (> or <24 hr), etiology of chronic renal failure, time on dialysis (> or <3 years) of the recipient, cause of donor's death (stroke, head trauma, anoxia, other causes of coma, tumor and others). We coded the value of mismatch. For each HLA, it was 0 when they shared the 2. Adding the 3 types of antigens, the possible mismatch values ranged between 0 and 6. However, all had values between 5 and 6. We used SPSS statistical software Medcalc 17.
We analyzed 345 (54%) men and 290 (46%) women. The average age was 12.5 + 3.9 years. The median follow-up time was 4 years (maximum 13 years). Patient survival rates at 30 days were 99.4%, at 1 year 96.8%, at 5 years 91.1%, and at 10 years 82.5%. Cox regression for patient survival: being a female and receiving HR 1.88 (95% CI 1.09-3.25) P = .023 or donor HR 1.86 (95% CI 1.06-3.25) P = .030. Tumor HR 17.19 (95% CI 4.48-65.98) P = <.0001. For recipient's age compared with <12 years >12 years HR 1.99 (95% CI 1.11-3.65) P = <.024. Graft survival rate at 30 days was 97.2%, at 1 year was 91.9%, at 5 years was 79.3% and at 10 years was 61.8%. Compared with donor's age <18 years: 45-59 years HR 2.52 (95% CI 1.42-4.47) P = .002. Glomerulonephritis HR 1.71 (95% CI 1.10-2.77) P = .018. Tumor as the cause of donor's death HR 4.39 (95% CI 1.28-2.28) P = .012. Time on dialysis > 3 years HR 1.59 (95% CI 1.11-2.28) P = .012.
Being a female, receiving a kidney from a woman and tumor as the cause of donor's death and age >12 years were associated with worse patient survival. Donor's age between 45 and 59, glomerulonephritis as the etiology of renal failure, tumor as the cause of death and time on dialysis >3 years were associated with lower graft survival.
由于手术技术和免疫系统抑制方面的进展，终末期肾病（ESRD）患儿的死亡率已大幅下降。肾移植已成为治疗儿科ESRD的主要方法。
从阿根廷国家器官采购与移植信息系统（SINTRA）获取1998 - 2009年期间的信息。我们使用Kaplan-Meier曲线，在30天、1年、5年和10年时测量生存率。用于患者和移植物生存的Cox回归变量包括供体和受体的性别与年龄、缺血时间（>或<24小时）、慢性肾衰竭的病因、受体的透析时间（>或<3年）、供体的死亡原因（中风、头部创伤、缺氧、其他昏迷原因、肿瘤及其他）。我们对错配值进行编码。对于每个HLA，当它们共享2个时为0。将3种抗原类型相加，可能的错配值范围在0至6之间。然而，所有值都在5至6之间。我们使用SPSS统计软件Medcalc 17。
我们分析了345名（54%）男性和290名（46%）女性。平均年龄为12.5±3.9岁。中位随访时间为4年（最长13年）。30天时患者生存率为99.4%，1年时为96.8%，5年时为91.1%，10年时为82.5%。患者生存的Cox回归分析：女性接受移植HR为1.88（95%CI 1.09 - 3.25），P = 0.023；供体为女性HR为1.86（95%CI 1.06 - 3.25），P = 0.030。肿瘤HR为17.19（95%CI 4.48 - 65.98），P = <0.0001。与年龄<12岁的受体相比，>12岁的受体HR为1.99（95%CI 1.11 - 3.65），P = <0.024。30天时移植物生存率为97.2%，1年时为91.9%，5年时为79.3%，10年时为61.8%。与供体年龄<18岁相比：45 - 59岁HR为2.52（95%CI 1.42 - 4.47），P = 0.002。肾小球肾炎HR为1.71（95%CI 1.10 - 2.77），P = 0.018。肿瘤作为供体死亡原因HR为4.39（95%CI 1.28 - 2.28），P = 0.012。透析时间>3年HR为1.59（95%CI 1.11 - 2.28），P = 0.012。
女性、接受女性供肾、肿瘤作为供体死亡原因以及年龄>12岁与较差的患者生存相关。供体年龄在45至59岁之间、肾小球肾炎作为肾衰竭病因、肿瘤作为死亡原因以及透析时间>3年与较低的移植物生存相关。
