Shu K-H, Ho H-C, Wen M-C, Wu M-J, Chen C-H, Cheng C-H, Yu T-M, Chuang Y-W, Huang S-T, Tsai S-F, Lo Y-C, Weng S-C
Division of Nephrology, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, Taiwan; Institute of Medicine, the Chung-Shan Medical University, Taichung, Taiwan.
Division of Urology, Department of Surgery, Taichung Veterans General Hospital, Taichung, Taiwan.
Transplant Proc. 2014;46(2):442-4. doi: 10.1016/j.transproceed.2013.11.032.
Patient survival among kidney transplant (KTx) recipients has improved remarkably in the past decades. The most common causes of death are cardiovascular disease in the West; in Taiwan, the answer remains uncertain.
From 1983 to 2012, KTx patients who underwent transplantation and were followed at our hospital were recruited for the study. For comparison, patients were stratified according to the transplant time as group 1, 1983-1989 (the initial era); group 2, 1990-1998 (the cyclosporine era); and group 3, 1999-2012 (the modern era, in which tacrolimus and mycophenolate mofetil were available).
A total of 520 KTx patients (male:female ratio of 285:235) were performed in our hospital during the study period. A progressive improvement in patient survival rates (P < .0001) was noted among the 3 groups. At a mean follow-up duration of 9.55 ± 8.20 years, 83 recipients had died. Overall, the most common cause of death was infection (44.6%), followed by cardiovascular disease (21.7%), malignancy (12.0%), and hepatic failure (10.8%). Infection was the main cause of death in groups 1 and 2 (44.1% and 52.6%, respectively) but not in Group 3 (18.2%), although this trend did not reach statistical significance. Death owing to cardiovascular diseases became the most common cause of death (27.3%) in the modern era (group 3).
The pattern of mortality among Taiwanese KTx patients has changed over the past 30 years. Infection is no longer the commonest cause of death.
在过去几十年中，肾移植（KTx）受者的患者生存率有了显著提高。在西方，最常见的死亡原因是心血管疾病；在台湾，答案仍不确定。
从1983年至2012年，招募在我院接受移植并随访的KTx患者进行研究。为作比较，根据移植时间将患者分为1组，1983 - 1989年（初始阶段）；2组，1990 - 1998年（环孢素时代）；3组，1999 - 2012年（现代阶段，可使用他克莫司和霉酚酸酯）。
在研究期间，我院共进行了520例KTx手术（男女比例为285:235）。3组患者的生存率呈逐步提高趋势（P <.0001）。平均随访时间为9.55 ± 8.20年，83例受者死亡。总体而言，最常见的死亡原因是感染（44.6%），其次是心血管疾病（21.7%）、恶性肿瘤（12.0%）和肝功能衰竭（10.8%）。感染是1组和2组的主要死亡原因（分别为4 .1%和52.6%），但在3组中不是主要原因（18.2%），尽管这种趋势未达到统计学意义。在现代阶段（3组），心血管疾病导致的死亡成为最常见的死亡原因（27.3%）。
在过去30年中，台湾KTx患者的死亡模式发生了变化。感染不再是最常见的死亡原因。
