University of British Columbia, Division of Nephrology, St. Paul's Hospital, Vancouver, Canada; Centre for Health Evaluation and Outcomes Sciences, Vancouver, Canada.
University of British Columbia, Division of Nephrology, St. Paul's Hospital, Vancouver, Canada; Centre for Health Evaluation and Outcomes Sciences, Vancouver, Canada.
Am J Kidney Dis. 2018 May;71(5):636-647. doi: 10.1053/j.ajkd.2017.11.012. Epub 2018 Feb 1.
The impact of dialysis exposure before nonpreemptive living donor kidney transplantation on allograft outcomes is uncertain.
Retrospective cohort study.
SETTING & PARTICIPANTS: Adult first-time recipients of kidney-only living donor transplants in the United States who were recorded within the Scientific Registry of Transplant Recipients for 2000 to 2016.
Duration of pretransplantation dialysis exposure.
Kidney transplant failure from any cause including death, death-censored transplant failure, and death with allograft function.
Among the 77,607 living donor transplant recipients studied, longer pretransplantation dialysis exposure was independently associated with progressively higher risk for transplant failure from any cause, including death beginning 6 months after transplantation. Compared with patients with 0.1 to 3.0 months of dialysis exposure, the HR for transplant failure from any cause including death increased from 1.16 (95% CI, 1.07-1.31) among patients with 6.1 to 9.0 months of dialysis exposure to 1.60 (95% CI, 1.43-1.79) among patients with more than 60.0 months of dialysis exposure. Pretransplantation dialysis exposure varied markedly among centers; median exposures were 11.0 and 18.9 months for centers in the 10th and 90th percentiles of dialysis exposure, respectively. Centers with the highest proportions of living donor transplantations had the shortest pretransplantation dialysis exposures. In multivariable analysis, patients of black race, with low income, with nonprivate insurance, with less than high school education, and not working for income had longer pretransplantation dialysis exposures. Dialysis exposure in patients with these characteristics also varied 2-fold between transplantation centers.
Why longer dialysis exposure is associated with transplant failure could not be determined.
Longer pretransplantation dialysis exposure in nonpreemptive living donor kidney transplantation is associated with increased risk for allograft failure. Pretransplantation dialysis exposure is associated with recipients' sociodemographic and transplantation centers' characteristics. Understanding whether limiting pretransplantation dialysis exposure could improve living donor transplant outcomes will require further study.
在非优先活体供肾移植前，透析暴露对移植物结局的影响尚不确定。
回顾性队列研究。
在美国，2000 年至 2016 年期间，在 Scientific Registry of Transplant Recipients 中记录的首次接受单纯活体供肾移植的成人患者。
移植前透析暴露时间。
任何原因导致的肾移植失败，包括死亡、死亡相关移植失败和有移植肾功能的死亡。
在 77607 例活体供肾移植受者中，较长的移植前透析暴露与更高的移植失败风险相关，包括移植后 6 个月开始的任何原因导致的死亡。与透析暴露 0.1 至 3.0 个月的患者相比，透析暴露 6.1 至 9.0 个月的患者，任何原因导致的移植失败风险比（HR）从 1.16（95%CI，1.07-1.31）增加到透析暴露超过 60.0 个月的患者的 1.60（95%CI，1.43-1.79）。移植前透析暴露在中心之间差异显著；透析暴露中位数分别为 11.0 和 18.9 个月，分别位于透析暴露第 10 和第 90 百分位的中心。接受活体供肾移植比例最高的中心，其移植前透析暴露时间最短。在多变量分析中，黑人、收入低、无私人保险、未完成高中学业、无收入的患者透析暴露时间更长。这些特征患者的透析暴露也在移植中心之间相差 2 倍。
为什么较长的透析暴露与移植失败相关，尚无法确定。
在非优先活体供肾移植中，移植前透析暴露时间延长与移植物失败风险增加相关。移植前透析暴露与受者的社会人口统计学和移植中心的特征有关。进一步的研究将需要确定是否限制移植前透析暴露可以改善活体供肾移植的结局。
