Division of Nephrology, Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA.
Clin Transplant. 2013 Jul-Aug;27(4):E435-41. doi: 10.1111/ctr.12173.
The majority of kidney transplant (KT) candidates spend some time on the transplant wait-list (WL) prior to kidney transplantation. We examined the impact of WL inactivity on clinical outcomes.
All adult KT candidates first actively wait-listed between January 1, 1996, and December 31, 2005, in the United States were grouped by frequency of inactivity on the WL. Transplantation rate, pre- and post-transplant patient survival and death-censored kidney graft survival were compared.
Of 159,774 candidates who were placed on the WL, 48,598 (30.4%) experienced one or more periods of inactivity. Candidates with inactivity once or more on the WL had 42% and 27% less likelihood of KT, respectively (HR 0.58, 95% CI 0.57, 0.59 and HR 0.73, 95% CI 0.71, 0.75). WL inactivity once or more was associated with a higher likelihood of death (HR 1.94, 95% CI 1.88, 2.00 and HR 2.13, 95% CI 2.02, 2.24). Among KT recipients, inactivity more than once on the WL was associated with a higher risk of death (HR 1.14, 95% CI 1.05, 1.23).
Periods of inactivity on the WL predict increased mortality pre- and post-transplantation. A better understanding of the reasons for WL inactivity is essential to improve WL management and post-transplant outcomes.
大多数肾移植（KT）候选者在接受肾移植之前，会在移植等待名单（WL）上等待一段时间。我们研究了 WL 不活跃对临床结果的影响。
所有在 1996 年 1 月 1 日至 2005 年 12 月 31 日期间首次在美国积极等待名单上的成年 KT 候选者，根据 WL 上的不活跃频率进行分组。比较了移植率、移植前和移植后患者生存率以及死亡相关肾移植存活率。
在 159774 名被列入 WL 的候选者中，有 48598 名（30.4%）经历了一次或多次 WL 不活跃。在 WL 上有一次或多次不活跃的候选者接受 KT 的可能性分别降低了 42%和 27%（HR 0.58，95%CI 0.57，0.59 和 HR 0.73，95%CI 0.71，0.75）。WL 不活跃一次或多次与死亡风险增加相关（HR 1.94，95%CI 1.88，2.00 和 HR 2.13，95%CI 2.02，2.24）。在接受 KT 的患者中，WL 上有一次以上的不活跃与死亡风险增加相关（HR 1.14，95%CI 1.05，1.23）。
WL 上的不活跃期预测了移植前和移植后的死亡率增加。更好地理解 WL 不活跃的原因对于改善 WL 管理和移植后结果至关重要。
