Kiberd Bryce A, Tennankore Karthik K, West Kenneth
Division of Nephrology, Department of Medicine, Dalhousie University, Room 5082 Dickson Building, Queen Elizabeth II HSC-VG site, 5280 University Avenue, Halifax B3H 1V8, NS, Canada.
Transplant Res. 2014 Jan 8;3(1):2. doi: 10.1186/2047-1440-3-2.
Determining eligibility for a kidney transplant is one of the most important decisions facing nephrologists. It is assumed that the harm of kidney transplantation is minimal and most will benefit. The purpose of this study was to quantify the probability of 'no benefit' as defined by death on the wait list; 'harm', defined by the probability that a transplanted patient would live less than the average wait listed patient; and 'benefit' for the probability a transplanted patient would outlive the average wait listed patient.
A computerized model was developed to replicate observed patient survival outcomes in deceased donor kidney transplantation. Three sequential periods of risk for the transplanted recipient compared to the wait listed cohort (increased, equivalent and reduced risk) were modeled.
The model predicted that wait listed patients with a baseline mortality of 28 deaths per 100 patient years were equally likely to benefit or be harmed with a transplant. However if 20% of patients on the wait list were on hold (assuming a 2.2-fold higher mortality than those who were transplanted), then the baseline mortality rate for equal harm or benefit decreases to 22 deaths per 100 patient years (equivalent life expectancy 4.5 years).
Patients with limited life expectancies are more likely to suffer some harm than derive benefit from kidney transplantation.
确定肾移植的合适人选是肾病学家面临的最重要决策之一。一般认为肾移植的危害极小，大多数人会从中受益。本研究的目的是量化按等待名单上死亡定义的“无获益”概率；按移植患者存活时间短于等待名单上患者平均存活时间定义的“危害”概率；以及按移植患者存活时间长于等待名单上患者平均存活时间定义的“获益”概率。
开发了一个计算机模型，以复制已故供体肾移植中观察到的患者生存结果。对移植受者与等待名单队列相比的三个连续风险期（风险增加、风险相当和风险降低）进行了建模。
该模型预测，每100患者年基线死亡率为28例死亡的等待名单上的患者接受移植后获益或受伤害的可能性相同。然而，如果等待名单上20%的患者被搁置（假设死亡率比接受移植的患者高2.2倍），那么同等伤害或获益的基线死亡率降至每100患者年22例死亡（预期寿命4.5年）。
预期寿命有限的患者接受肾移植更有可能遭受一些伤害而非获益。
