Ritchie Angus G, Clayton Philip A, McDonald Stephen P, Kennedy Sean E
School of Women's and Children's Health, University of New South Wales, Sydney, New South Wales, Australia.
Department of Nephrology, Sydney Children's Hospital, Randwick, New South Wales, Australia.
Nephrology (Carlton). 2018 Jun;23(6):585-591. doi: 10.1111/nep.13067.
The aims of this study were to identify if an age-specific high-risk window for graft loss is present in Australia and New Zealand and identify the aetiology for such graft loss using the Australia and New Zealand Dialysis and Transplant Registry.
Retrospective cohort analysis of all renal transplants were performed in Australia and New Zealand during 1985-2010 in which the graft survived >3 months and the patient spent at least some time aged 10-30 years inclusive while the graft was functioning. Adjusted hazard ratio (aHR) for graft loss according to age, sex, race, cause of end-stage kidney disease, transition, era of transplantation, donor type and human leucocyte antigen mismatch were calculated using an extended Cox proportional hazards model for graft loss from any cause and graft loss from late acute rejection (LAR) or non-compliance.
A total of 3289 grafts in 3048 recipients were included. A total of 757 grafts failed including 110 (15 %) from LAR or non-compliance. Age was strongly associated with graft loss from LAR or non-compliance (p < 0.001). Compared with age 10-12 years, the risk of graft loss from LAR or non-compliance was significantly increased from 16-24 years, peaking at 19-21 years (aHR 11.3, 95% confidence interval (CI) 1.5-84.3, p < 0.001). Indigenous race was associated with LAR or non-compliance (aHR 3.5, 95% CI 2.1-5.6) whereas paediatric-to-adult transition with a functioning transplant was not (aHR 1.2, 95% CI 0.4-3.5, p = 0.68).
The high risk of graft loss during adolescence and young adulthood is primarily due to LAR or non-compliance. The elevated risk continues well into the 20s and is independent of paediatric-to-adult transition.
本研究旨在确定在澳大利亚和新西兰是否存在特定年龄的移植肾丢失高风险期，并利用澳大利亚和新西兰透析与移植登记处的数据确定此类移植肾丢失的病因。
对1985年至2010年期间在澳大利亚和新西兰进行的所有肾移植进行回顾性队列分析，这些移植肾存活时间超过3个月，且患者在移植肾功能期间至少有一段时间年龄在10至30岁（含）之间。使用扩展的Cox比例风险模型计算因年龄、性别、种族、终末期肾病病因、过渡期、移植时代、供体类型和人类白细胞抗原错配导致的移植肾丢失的调整风险比（aHR），以评估任何原因导致的移植肾丢失以及晚期急性排斥反应（LAR）或不依从导致的移植肾丢失情况。
共纳入3048例受者的3289个移植肾。共有757个移植肾失败，其中110个（15%）因LAR或不依从。年龄与LAR或不依从导致的移植肾丢失密切相关（p<0.001）。与10至12岁相比，16至24岁时LAR或不依从导致的移植肾丢失风险显著增加，在19至21岁时达到峰值（aHR 11.3，95%置信区间（CI）1.5 - 84.3，p<0.001）。原住民种族与LAR或不依从相关（aHR 3.5，95% CI 2.1 - 5.6），而移植肾功能正常的儿童向成人过渡期则不然（aHR 1.2，95% CI 0.4 - 3.5，p = 0.68）。
青春期和成年早期移植肾丢失的高风险主要归因于LAR或不依从。这种风险升高在20多岁时仍持续存在，且与儿童向成人的过渡期无关。
