Parajuli Sandesh, Redfield Robert R, Astor Brad C, Djamali Arjang, Kaufman Dixon B, Mandelbrot Didier A
Division of Nephrology, Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA.
Division of Transplant Surgery, University of Wisconsin Hospital and Clinics, Madison, WI, USA.
Clin Transplant. 2017 Mar;31(3). doi: 10.1111/ctr.12895. Epub 2017 Jan 29.
Since the institution of the new kidney allocation system in December 2014, kidney transplant candidates with the highest calculated panel reactive antibodies (cPRA) of 99-100 have been transplanted at much higher rates. However, concerns have been raised that outcomes in these patients might be impaired due to higher immunological risk and longer cold ischemia times resulting from long-distance sharing of kidneys. Here, we compare outcomes at the University of Wisconsin between study patients with cPRA 99-100 and all other recipients of deceased donor kidneys transplanted between 12/04/2014 and 12/31/2015. All patients had at least 6 months post-transplant follow-up. The mean follow-up was 13.9±3 months in cPRA ≥99% and 12.3±3.5 months in cPRA ≤98%. There was a total of 152 transplants, 25 study patients, and 127 controls. No statistically significant differences were found between the two groups in delayed graft function, rejection, kidney function, graft and patient survival, or infections. We conclude that transplanting the most highly sensitized patients with kidneys shared outside their local donation service areas is associated with excellent short-term outcomes that are comparable to controls.
自2014年12月新的肾脏分配系统实施以来，计算得出的群体反应性抗体（cPRA）最高值为99 - 100的肾脏移植候选者的移植率要高得多。然而，有人担心这些患者的预后可能会因免疫风险较高以及肾脏远距离共享导致的冷缺血时间延长而受到影响。在此，我们比较了威斯康星大学中cPRA为99 - 100的研究患者与2014年4月12日至2015年12月31日期间接受已故供体肾脏移植的所有其他受者的预后情况。所有患者移植后至少随访6个月。cPRA≥99%的患者平均随访时间为13.9±3个月，cPRA≤98%的患者平均随访时间为12.3±3.5个月。共有152例移植手术，25例研究患者和127例对照。两组在移植肾功能延迟恢复、排斥反应、肾功能、移植物和患者生存率或感染方面均未发现统计学上的显著差异。我们得出结论，将高度致敏患者与当地捐赠服务区以外共享的肾脏进行移植，其短期预后良好，与对照组相当。
