González-Molina Miguel, Burgos Dolores, Cabello Mercedes, Ruiz-Esteban Pedro, Rodríguez Manuel A, Gutiérrez Cristina, López Verónica, Baena Víctor, Hernández Domingo
Nefrologia. 2014;34(5):570-8. doi: 10.3265/Nefrologia.pre2014.Jun.12327.
We analyzed graft half-life and attrition rates in 1045 adult deceased donor kidney transplants from 1986-2001, with follow-up to 2011, grouped in two periods (1986-95 vs. 1996-01) according to immunosuppression. The Kaplan-Meier curve showed a significant increase in graft survival during 1996-2001. The uncensored real graft half-life was 10.25 years in 1986-95 and the actuarial was 14.58 years in 1996-2001 (P<0.001). The attrition rates showed a significantly greater graft loss in 1986-95, even excluding the first year from the analysis. The decline in renal function was significantly less pronounced in 1996-2001, indicating better preservation of renal function, despite the increase in donor age and stroke as the cause of donor death. The parsimonious Cox multivariate model showed donor age, acute rejection, panel reactive antibody, cold ischemia time and delayed graft function were significantly associated with a higher risk of graft loss. In contrast, the risk of graft loss fell by 21% in 1996-2001 compared with 1986-95. A similar reduction (25%) was observed when MMF treatment was entered into the multivariate model instead of study period. Long-term graft survival improved significantly in 1996-2001 compared to 1986-1995 despite older donor age. Modern immunosuppression could have contributed to the improved kidney transplant outcome.
我们分析了1986年至2001年期间1045例成人尸体供肾移植的移植物半衰期和损耗率，并随访至2011年，根据免疫抑制情况分为两个时期（1986 - 1995年与1996 - 2001年）。Kaplan - Meier曲线显示1996 - 2001年期间移植物存活率显著提高。1986 - 1995年未删失的实际移植物半衰期为10.25年，1996 - 2001年精算半衰期为14.58年（P<0.001）。损耗率显示1986 - 1995年移植物丢失显著更多，即使在分析中排除第一年也是如此。1996 - 2001年肾功能下降明显不那么显著，这表明尽管供体年龄增加且供体死亡原因是中风，但肾功能得到了更好的保存。简约Cox多变量模型显示供体年龄、急性排斥反应、群体反应性抗体、冷缺血时间和移植肾功能延迟与移植物丢失风险显著相关。相比之下，与1986 - 1995年相比，1996 - 2001年移植物丢失风险下降了21%。当将霉酚酸酯治疗纳入多变量模型而非研究时期时，观察到类似的降低（25%）。尽管供体年龄较大，但与1986 - 1995年相比，1996 - 2001年长期移植物存活率显著提高。现代免疫抑制可能有助于改善肾移植结果。
