Tasaki M, Saito K, Nakagawa Y, Ikeda M, Imai N, Ito Y, Narita I, Takahashi K
Division of Urology, Department of Regenerative & Transplant Medicine, Niigata Graduate School of Medical and Dental Sciences, Niigata, Japan.
Division of Urology, Department of Regenerative & Transplant Medicine, Niigata Graduate School of Medical and Dental Sciences, Niigata, Japan.
Transplant Proc. 2014;46(2):437-41. doi: 10.1016/j.transproceed.2013.10.052.
Patient and graft survival after successful kidney transplantation (KT) have improved despite an increase in the number of challenging cases. Various factors have evolved during the long history of kidney transplantation.
Between 1988 and 2012, a total of 292 living donor and 56 deceased donor KTs were performed at Niigata University Hospital. Long-term patient and graft survival and changes in background during a 20-year period in a single center were retrospectively analyzed.
Excellent patient survival rates of 95.1% at 20 years for living donor KT and 96.2% at 15 years for deceased donor KT were observed. Graft survival rates at 1, 5, 10, 15, and 20 years were 96.8%, 95.4%, 83.1%, 61.8%, and 56.2% in living donor KT, respectively. In contrast, graft survival rates at 1, 5, 10, and 15 years in deceased donor KT were 89.0%, 80.3%, 77.3%, and 33.8%, respectively. These survival rates have dramatically improved since 2002 (91.7% for living and 80.9% for deceased donor KT at 10 years post-transplantation). The number of elderly recipients (older than 60 years) and the percentage of grafts donated from spouses have increased. The rejection rate decreased and the cytomegalovirus antigenemia-positive rate increased during the 20-year period assessed. The percentage of pre-emptive KTs progressively increased, with graft survival in this group tending to be better than non-preemptive KTs. The causes of graft loss were chronic allograft dysfunction (54.7%), acute rejection (11.1%), and malignancies (9.4%). After living donor KT, the principal predictors of graft loss were if the recipient was younger than 30 years, if the donor was older than 50 years, and if the rejection episodes occurred after living donor KT. In contrast, the only risk factor in the case of deceased donor KT occurred after transplantation from donors who were older than 50 years.
A summary of the long-term outcome of KT over 20 years in a single center has been reported. Along with the changes in patient backgrounds, immunosuppressive drugs, and our knowledge of transplantation, patient and graft survival outcomes have also changed. Investigation into such outcomes during a different transplantation era is required to fully appreciate advances in KT.
尽管具有挑战性的病例数量有所增加，但成功的肾移植（KT）后患者和移植物的存活率仍有所提高。在肾移植的漫长历史中，各种因素不断演变。
1988年至2012年期间，新潟大学医院共进行了292例活体供肾和56例尸体供肾肾移植手术。对单一中心20年期间的长期患者和移植物存活率以及背景变化进行了回顾性分析。
观察到活体供肾肾移植20年时患者存活率高达95.1%，尸体供肾肾移植15年时患者存活率为96.2%。活体供肾肾移植1、5、10、15和20年时的移植物存活率分别为96.8%、95.4%、83.1%、61.8%和56.2%。相比之下，尸体供肾肾移植1、5、10和15年时的移植物存活率分别为89.0%、80.3%、77.3%和33.8%。自2002年以来，这些存活率有了显著提高（移植后10年时，活体供肾肾移植为91.7%，尸体供肾肾移植为80.9%）。老年受者（60岁以上）的数量以及配偶捐献移植物的比例有所增加。在评估的20年期间，排斥反应发生率下降，巨细胞病毒抗原血症阳性率上升。抢先肾移植的比例逐渐增加，该组的移植物存活率往往优于非抢先肾移植。移植物丢失的原因包括慢性移植物功能障碍（54.7%）、急性排斥反应（11.1%）和恶性肿瘤（9.4%）。活体供肾肾移植后，移植物丢失的主要预测因素是受者年龄小于30岁、供者年龄大于50岁以及活体供肾肾移植后发生排斥反应。相比之下，尸体供肾肾移植的唯一危险因素是供者年龄大于50岁。
报告了单一中心20年肾移植的长期结果总结。随着患者背景、免疫抑制药物以及我们对移植的认识的变化，患者和移植物的存活结果也发生了改变。需要对不同移植时代的此类结果进行调查，以充分了解肾移植的进展。
