Keith Douglas Scott, Vranic Gayle, Nishio-Lucar Angie
Sacred Heart Kidney Transplant Program, Sacred Heart Hospital, Pensacola, FL.
Division of Nephrology, University of Virginia, Charlottesville, VA.
Transplant Direct. 2017 May 25;3(6):e166. doi: 10.1097/TXD.0000000000000654. eCollection 2017 Jun.
Previous analyses of the United States transplant database regarding long-term outcomes in kidney transplantation have shown minimal improvement in the rate of long-term graft loss. This study sought to analyze intermediate-term outcomes and graft function at 6 months in kidney transplantation in adult living and deceased donor recipients in the last decade.
Survival analysis was performed based on the year of transplant between 6 months and 3 years' posttransplant. The Chronic Kidney Disease Epidemiology Collaboration estimated glomerular filtration rate (eGFR) was determined at 6 months.
The unadjusted graft survival between 6 months and 3 years improved significantly in the latter half of the decade in both deceased and living donor kidney recipients. Cox analysis showed a 33% reduction in the rate of graft loss and that the improvement in graft survival was due to similar improvements in both death-censored graft and death with graft function survival. A 10% improvement in median eGFR occurred despite worsening donor demographics over time in both donor types. This improvement in eGFR and graft survival occurred in association with a consolidation of chronic discharge immunosuppression from a variety of combinations to over 85% of recipients receiving tacrolimus and mycophenolate derivative immunosuppression.
In the latter half of last decade graft survival improved in adult kidney transplant recipients. The improvement in graft survival occurred in temporal association with an improvement in median eGFR at 6 months and consolidation of discharge immunosuppression in most patients to tacrolimus and mycophenolate derivatives.
先前对美国移植数据库中肾移植长期预后的分析显示，长期移植物丢失率的改善微乎其微。本研究旨在分析过去十年中成年活体和 deceased 供体肾移植受者在术后 6 个月时的中期预后和移植物功能。
基于移植后 6 个月至 3 年之间的移植年份进行生存分析。在术后 6 个月时测定慢性肾脏病流行病学协作组估计的肾小球滤过率（eGFR）。
在这十年的后半期， deceased 和活体供肾受者在术后 6 个月至 3 年期间的未调整移植物存活率均有显著提高。Cox 分析显示移植物丢失率降低了 33%，移植物存活率的提高归因于死亡截尾移植物和带移植物功能存活的死亡情况均有类似改善。尽管随着时间推移供体人口统计学特征恶化，但两种供体类型的 eGFR 中位数均提高了 10%。eGFR 和移植物存活率的这种改善与慢性出院免疫抑制从多种组合合并为超过 85%的受者接受他克莫司和霉酚酸酯衍生物免疫抑制有关。
在过去十年的后半期，成年肾移植受者的移植物存活率有所提高。移植物存活率的提高与术后 6 个月时 eGFR 中位数的改善以及大多数患者出院免疫抑制合并为他克莫司和霉酚酸酯衍生物在时间上相关。
