Division of Nephrology, St. Michael's Hospital, Toronto, Ontario, Canada; Renal Transplant Program, St. Michael's Hospital, Toronto, Ontario, Canada.
Renal Transplant Program, St. Michael's Hospital, Toronto, Ontario, Canada.
Kidney Int. 2016 May;89(5):1119-1124. doi: 10.1016/j.kint.2015.12.047. Epub 2016 Mar 9.
Transplant tourism, a form of transplant commercialization, has resulted in serious short-term adverse outcomes that explain reduced short-term kidney allograft survival. However, the nature of longer-term outcomes in commercial kidney transplant recipients is less clear. To study this further, we identified 69 Canadian commercial transplant recipients of 72 kidney allografts transplanted during 1998 to 2013 who reported to our transplant center for follow-up care. Their outcomes to 8 years post-transplant were compared with 702 domestic living donor and 827 deceased donor transplant recipients during this period using Kaplan-Meier survival plots and multivariate Cox regression analysis. Among many complications, notable specific events included hepatitis B or C seroconversion (7 patients), active hepatitis and/or fulminant hepatic failure (4 patients), pulmonary tuberculosis (2 patients), and a type A dissecting aortic aneurysm. Commercial transplantation was independently associated with significantly reduced death-censored kidney allograft survival (hazard ratio 3.69, 95% confidence interval 1.88-7.25) along with significantly delayed graft function and eGFR 30 ml/min/1.73 m(2) or less at 3 months post-transplant. Thus, commercial transplantation represents an important risk factor for long-term kidney allograft loss. Concerted arguments and efforts using adverse recipient outcomes among the main premises are still required in order to eradicate transplant commercialization.
器官移植旅游，一种器官买卖形式，导致了严重的短期不良后果，解释了短期肾移植存活率的降低。然而，商业肾移植受者的长期后果的性质不太清楚。为了进一步研究这个问题，我们确定了 69 名加拿大商业器官移植受者，他们在 1998 年至 2013 年期间接受了 72 个肾脏移植，他们向我们的移植中心报告了随访护理情况。通过 Kaplan-Meier 生存图和多变量 Cox 回归分析，将他们在移植后 8 年的结果与同期 702 名国内活体供者和 827 名已故供者移植受者的结果进行了比较。在许多并发症中，值得注意的特定事件包括乙型肝炎或丙型肝炎血清转换（7 例）、活动性肝炎和/或暴发性肝衰竭（4 例）、肺结核（2 例）和 A 型夹层主动脉瘤。商业移植与死亡风险调整后的肾移植存活率显著降低（风险比 3.69，95%置信区间 1.88-7.25）以及移植物功能延迟和移植后 3 个月时 eGFR 为 30 ml/min/1.73 m2 或更低有关。因此，商业移植是长期肾移植丧失的一个重要危险因素。仍然需要利用主要前提中的受者不良后果进行一致的争论和努力，以消除器官买卖。
