Panchal Hinaben, Muskovich Justin, Patterson Jeromy, Schroder Paul M, Ortiz Jorge
Department of Surgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
Department of Surgery, Albert Einstein Medical Center, Philadelphia, PA, USA.
Transpl Int. 2015 Aug;28(8):990-9. doi: 10.1111/tri.12584. Epub 2015 Apr 23.
This study analyzed outcomes of retransplantation from expanded criteria donors (ECD) over the last two decades to determine the benefits and risks of using ECD kidneys for retransplantation. Data from the United Network for Organ Sharing database were collected and analyzed. Graft survival, death-censored graft survival, and patient survival for retransplantation with ECD kidneys (re-ECD) were reported and compared with primary transplantation with ECD kidneys (prim-ECD) and retransplantation with standard criteria donor kidneys (re-SCD). Re-ECD kidneys had higher risk of graft failure compared with prim-ECD (hazard ratio [HR] = 1.19) and to re-SCD (HR = 1.76). Patient survival was better in re-ECD compared with prim-ECD (HR = 0.89) but was worse than re-SCD (HR = 1.82). After censoring the patients who died with a functioning graft, re-ECD had a higher mortality risk compared with prim-ECD (HR = 1.45) and re-SCD (HR = 1.79). Transplantation improves quality of life and reduces healthcare costs, and due to the risk associated with resumption of hemodialysis and the longer waiting list times for SCD kidneys, there is a benefit to accepting ECD kidneys for select patients requiring retransplantation. Although this benefit exists for select patients, retransplantation with ECD kidneys should be undertaken with trepidation, and appropriate informed consent should be obtained.
本研究分析了过去二十年中来自扩大标准供体（ECD）的再次移植的结果，以确定使用ECD肾脏进行再次移植的益处和风险。收集并分析了器官共享联合网络数据库的数据。报告了使用ECD肾脏进行再次移植（re-ECD）的移植物存活率、死亡截尾移植物存活率和患者存活率，并与使用ECD肾脏进行初次移植（prim-ECD）以及使用标准标准供体肾脏进行再次移植（re-SCD）进行了比较。与prim-ECD相比，re-ECD肾脏发生移植物失败的风险更高（风险比[HR]=1.19），与re-SCD相比也是如此（HR=1.76）。与prim-ECD相比，re-ECD患者的存活率更好（HR=0.89），但比re-SCD差（HR=1.82）。在对移植物功能良好时死亡的患者进行截尾后，与prim-ECD相比，re-ECD的死亡风险更高（HR=1.45），与re-SCD相比也是如此（HR=1.79）。移植可改善生活质量并降低医疗成本，并且由于恢复血液透析相关的风险以及等待SCD肾脏的时间更长，对于某些需要再次移植的患者来说，接受ECD肾脏是有好处的。尽管这种好处存在于某些特定患者中，但使用ECD肾脏进行再次移植应谨慎进行，并应获得适当的知情同意。
