Okumi Masayoshi, Sato Yasuyuki, Unagami Kohei, Hirai Toshihito, Ishida Hideki, Tanabe Kazunari
Department of Urology, Tokyo Women's Medical University, 8-1 Kawada-cho, Shinjuku, Tokyo, 162-8666, Japan.
Department of Medicine, Kidney Center, Tokyo Women's Medical University, Tokyo, Japan.
Clin Exp Nephrol. 2017 Dec;21(6):1105-1112. doi: 10.1007/s10157-016-1345-x. Epub 2016 Oct 19.
The reasons for improved outcomes associated with preemptive kidney transplantation (PKT) are incompletely understood, and post-transplant complications have been scarcely investigated.
We evaluated the outcomes of PKT in both unmatched (n = 1060) and propensity score matched cohorts (n = 186) of adults who underwent living kidney transplant between 2000 and 2014. Outcomes were estimated glomerular filtration rate (eGFR), biopsy-proven rejection, cytomegalovirus (CMV) infection, post-transplant diabetes mellitus (PTDM), cardiovascular disease (CVD), graft failure (non-censored for death), and malignancy. Primary endpoint was post-transplant renal function assessed with eGFR.
A total of 95 patients (9.0 %) underwent PKT. The 2-week mean eGFR after transplant was comparable between the matched PKT and non-PKT groups (45.2 vs. 46.5 mL/min/1.73 m, respectively, P = 0.56). Sensitivity analysis using various formulas did not change the results. PKT was not superior to non-PKT in reducing the risk of biopsy-proven rejection, CMV, PTDM, and malignancy, regardless of matching. The risk of graft failure and CVD was significantly reduced in the unmatched PKT group (ARR, -6.2 %; 95 % CI, -8.6 to -0.7; P = 0.03, and ARR, -6.7 %; 95 % CI, -9.6 to -0.7, P = 0.03, respectively); nevertheless, the corresponding ARRs were -3.2 % (95 % CI, -10.0 to 2.9; P = 0.44) and -2.2 % (95 % CI, -9.1 to 4.4; P = 0.72) after matching.
PKT was associated with neither improvement of post-transplant renal function nor a lower rate of common post-transplant complications than non-PKT among patients with end-stage renal disease who underwent living KT.
与抢先肾移植（PKT）相关的预后改善原因尚未完全明确，且对移植后并发症的研究较少。
我们评估了2000年至2014年间接受活体肾移植的成人非匹配队列（n = 1060）和倾向评分匹配队列（n = 186）中PKT的预后。预后指标包括估计肾小球滤过率（eGFR）、活检证实的排斥反应、巨细胞病毒（CMV）感染、移植后糖尿病（PTDM）、心血管疾病（CVD）、移植失败（不包括因死亡而 censored）和恶性肿瘤。主要终点是用eGFR评估的移植后肾功能。
共有95例患者（9.0%）接受了PKT。匹配的PKT组和非PKT组移植后2周的平均eGFR相当（分别为45.2和46.5 mL/min/1.73 m²，P = 0.56）。使用各种公式进行的敏感性分析并未改变结果。无论是否匹配，PKT在降低活检证实的排斥反应、CMV、PTDM和恶性肿瘤风险方面均不优于非PKT。在非匹配的PKT组中，移植失败和CVD的风险显著降低（绝对风险降低率[ARR]，-6.2%；95%置信区间，-8.6至-0.7；P = 0.03，以及ARR，-6.7%；95%置信区间，-9.6至-0.7，P = 0.03）；然而，匹配后相应的ARR分别为-3.2%（95%置信区间，-10.0至2.9；P = 0.44）和-2.2%（95%置信区间，-9.1至4.4；P = 0.72）。
在接受活体肾移植的终末期肾病患者中，PKT与移植后肾功能改善无关，且与非PKT相比，移植后常见并发症的发生率也没有降低。
