Osho Asishana A, Hirji Sameer A, Castleberry Anthony W, Mulvihill Michael S, Ganapathi Asvin M, Speicher Paul J, Yerokun Babatunde, Snyder Laurie D, Davis Robert D, Hartwig Mathew G
Department of Surgery, Massachusetts General Hospital, Boston, MA, USA.
Department of Surgery, Brigham and Women's Hospital, Boston, MA, USA.
Clin Transplant. 2017 May;31(5). doi: 10.1111/ctr.12953. Epub 2017 Apr 17.
Kidney transplantation has been advocated as a therapeutic option in lung recipients who develop end-stage renal disease (ESRD). This analysis outlines patterns of allograft survival following kidney transplantation in previous lung recipients (KAL).
Data from the UNOS lung and kidney transplantation registries (1987-2013) were cross-linked to identify lung recipients who were subsequently listed for and/or underwent kidney transplantation. Time-dependent Cox models compared the survival rates in KAL patients with those waitlisted for renal transplantation who never received kidneys. Survival analyses compared outcomes between KAL patients and risk-matched recipients of primary, kidney-only transplantation with no history of lung transplantation (KTx).
A total of 270 lung recipients subsequently underwent kidney transplantation (KAL). Regression models demonstrated a lower risk of post-listing mortality for KAL patients compared with 346 lung recipients on the kidney waitlist who never received kidneys (P<.05). Comparisons between matched KAL and KTx patients demonstrated significantly increased risk of death and graft loss (P<.05), but not death-censored graft loss, for KAL patients (P = .86).
KAL patients enjoy a significant survival benefit compared with waitlisted lung recipients who do not receive kidneys. However, KAL patients do poorly compared with KTx patients. Decisions about KAL transplantation must be made on a case-by-case basis considering patient and donor factors.
对于终末期肾病（ESRD）的肺移植受者，肾移植已被视为一种治疗选择。本分析概述了既往肺移植受者（KAL）肾移植后的同种异体移植物存活模式。
对美国器官共享联合网络（UNOS）肺和肾移植登记处（1987 - 2013年）的数据进行交叉关联，以确定随后被列入肾移植名单和/或接受肾移植的肺移植受者。时间依赖性Cox模型比较了KAL患者与从未接受肾脏移植的肾移植等待者的存活率。生存分析比较了KAL患者与无肺移植史的原发性单纯肾移植风险匹配受者（KTx）的结局。
共有270例肺移植受者随后接受了肾移植（KAL）。回归模型显示，与346例从未接受肾脏移植的肾移植等待名单上的肺移植受者相比，KAL患者在列入名单后的死亡风险更低（P <.05）。匹配的KAL和KTx患者之间的比较表明，KAL患者的死亡和移植物丢失风险显著增加（P <.05），但死亡审查后的移植物丢失风险没有增加（P = 0.86）。
与未接受肾脏移植的等待名单上的肺移植受者相比，KAL患者享有显著的生存益处。然而，与KTx患者相比，KAL患者的情况较差。关于KAL移植的决策必须根据患者和供体因素逐案做出。
