Trnka Peter, McTaggart Steven J, Francis Anna
Child and Adolescent Renal Service, Children's Health Queensland, South Brisbane, Australia.
School of Medicine, University of Queensland, Brisbane, Australia.
Pediatr Transplant. 2018 Nov;22(7):e13265. doi: 10.1111/petr.13265. Epub 2018 Jul 11.
Understanding the relationship between the factors that influence long-term kidney transplant survival remains a key priority for pediatric nephrologists. We assessed the relative impact of donor/recipient age difference and HLA matching on long-term graft outcomes.
We conducted a retrospective cohort study of pediatric and adolescent recipients who received a primary kidney transplant in Australia and New Zealand between January 1, 1990, and December 31, 2015. The primary outcome was graft survival analyzed by Kaplan-Meier method.
During the 26-year period, 1134 primary (395 DD and 739 LD) kidney transplants were performed in recipients less than 20 years of age. The median follow-up time was 10.2 years. Overall, 405 patients (35.7%) lost their transplant with graft survival 93.8% at 1 year, 82.5% at 5 years, 65.8% at 10 years, and 49.9% at 15 years post-transplant. There was consistently higher graft loss of DD kidneys as compared to LD kidneys at each time point. Both increasing donor/recipient age difference (aHR 1.11 per 10 years; 95% CI, 1.02-1.20; P = 0.009) and increasing HLA mismatch (aHR 1.20 per mismatch; 95% CI, 1.10-1.30; P < 0.001) were associated with decreased graft survival.
Donor/recipient age difference and HLA matching are important factors influencing long-term graft outcomes in pediatric kidney transplantation. HLA mismatch remains a strong predictor of graft loss. For patients without the option of a LD, we suggest that the degree of HLA mismatch should not be discounted as part of the decision-making process of organ allocation.
了解影响肾移植长期存活的因素之间的关系仍然是儿科肾病学家的关键优先事项。我们评估了供体/受体年龄差异和HLA配型对长期移植结局的相对影响。
我们对1990年1月1日至2015年12月31日期间在澳大利亚和新西兰接受首次肾移植的儿童和青少年受者进行了一项回顾性队列研究。主要结局是通过Kaplan-Meier方法分析的移植肾存活情况。
在这26年期间，对年龄小于20岁的受者进行了1134例首次（395例活体供肾和739例尸体供肾）肾移植。中位随访时间为10.2年。总体而言，405例患者（35.7%）移植肾失功，移植后1年移植肾存活率为93.8%，5年为82.5%，10年为65.8%，15年为49.9%。在每个时间点，活体供肾移植肾的失功率始终高于尸体供肾移植肾。供体/受体年龄差每增加10岁（调整后风险比1.11；95%置信区间，1.02-1.20；P = 0.009）以及HLA错配数增加（每增加一个错配调整后风险比1.20；95%置信区间，1.10-1.30；P < 0.001）均与移植肾存活率降低相关。
供体/受体年龄差异和HLA配型是影响儿童肾移植长期移植结局的重要因素。HLA错配仍然是移植肾失功的有力预测指标。对于没有活体供肾选择的患者，我们建议在器官分配的决策过程中，不应忽视HLA错配程度。
