Kim Hye Yeon, Choi Ji Yoon, Kwon Hyun Wook, Jung Joo Hee, Han Minkyu, Park Su-Kil, Kim Soon Bae, Lee Sang Koo, Kim Young Hoon, Han Duck Jong, Shin Sung
Division of Kidney and Pancreas Transplantation, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea.
Department of Clinical Epidemiology and Biostatistics, Asan Medical Center, Seoul, South Korea.
Ann Transplant. 2019 Feb 11;24:75-83. doi: 10.12659/AOT.913126.
BACKGROUND The permissible extent of pretransplant dialysis for patient and allograft survival is unclear. We assumed that a short period of dialysis before living donor kidney transplantation (LDKT) will show the similar results as preemptive kidney transplantation (PKT). MATERIAL AND METHODS We retrospectively evaluated the outcomes of LDKT according to pretransplant dialysis duration in both unmatched cohorts (n=1984) and propensity-score-matched cohorts (n=986) cohorts. The primary study endpoint was post-transplantation patient survival and death-censored graft survival (DCGS) according to the duration of pretransplant dialysis by 19 months which was the best cutoff value to differentiate clinical outcomes with the use of the time-dependent area under the curve. RESULTS Of 1984 patients with LDKT at our center between January 2005 and September 2016, PKT was performed in 429 patients. The durations of pretransplant dialysis were <19 months in 962 recipients and ≥19 months in 593 recipients. There was no significant difference in mortality and DCGS between PKT and non-PKT recipients with pretransplant dialysis of <19 months. Patient survival (P=0.024) and DCGS (P=0.001) were worse in non-PKT recipients with pretransplant dialysis of ≥19 months. In the matched cohort, DCGS was significantly lower in non-PKT recipients with pretransplant dialysis of ≥19 months (P=0.037). It is likely that the incidence of biopsy-proven acute rejection was higher in this group (P=0.083). CONCLUSIONS Patient survival and DCGS were worse when the pretransplant dialysis duration was ³19 months in a propensity-score-matched LDKT cohort.
移植前透析对患者和移植肾存活的允许范围尚不清楚。我们假设活体供肾移植（LDKT）前短时间透析的结果与抢先肾移植（PKT）相似。材料与方法：我们回顾性评估了未匹配队列（n = 1984）和倾向评分匹配队列（n = 986）中根据移植前透析时间的LDKT结果。主要研究终点是根据移植前透析19个月的时间进行的移植后患者存活和死亡删失移植肾存活（DCGS），19个月是使用时间依赖性曲线下面积来区分临床结果的最佳截断值。结果：在2005年1月至2016年9月期间，我们中心有1984例LDKT患者，其中429例进行了PKT。962例受者的移植前透析时间<19个月，593例受者的移植前透析时间≥19个月。移植前透析时间<19个月的PKT和非PKT受者之间的死亡率和DCGS无显著差异。移植前透析时间≥19个月的非PKT受者的患者存活（P = 0.024）和DCGS（P = 0.001）较差。在匹配队列中，移植前透析时间≥19个月的非PKT受者的DCGS显著较低（P = 0.037）。该组活检证实的急性排斥反应发生率可能较高（P = 0.083）。结论：在倾向评分匹配的LDKT队列中，移植前透析时间≥19个月时，患者存活和DCGS较差。
