改变实践对英国儿科肾移植改善结局的影响：25 年回顾。

The impact of changing practice on improved outcomes of paediatric renal transplantation in the United Kingdom: a 25 years review.

机构信息

Statistics and Clinical Studies, NHS Blood and Transplant, Bristol, UK.

Royal Hospital for Children, Glasgow, UK.

出版信息

Transpl Int. 2019 Jul;32(7):751-761. doi: 10.1111/tri.13418. Epub 2019 Mar 26.

DOI:10.1111/tri.13418

PMID:30801866

Abstract

This review reports the outcomes of paediatric renal transplantation in the United Kingdom over the last 25 years. UK Transplant Registry data on 3236 paediatric renal transplants performed between 1 January 1992 and 31 December 2016 were analysed. Significant improvements in human leucocyte antigen (HLA) matching have been achieved; 84% of recipients received 000 or favourable (0 DR and 0 or 1 B) mismatched kidneys in 2016 compared with 27% in 1992. The median waiting time has increased from 126 days in 1999 to 351 days in 2016. Tacrolimus replaced ciclosporin in most immunosuppressive regimens after 2002. Renal transplant outcome has improved significantly, mainly because of a reduction in early graft loss. One-year donation after brain death renal allograft survival for those transplanted from 2012 to 2016 was 98%, compared with 72% for those transplanted from 1987 to 1991. Renal allograft survival for first kidney only transplants at 1, 5, 10, 20 and 25 years were 89%, 79%, 65%, 42% and 33% respectively. Superior survival with living donor was maintained throughout the study period with 25-year graft survival at 33% compared with 31% from deceased donor (P < 0.0001). Changes in immunosuppression regimens, improvements in HLA matching and a reduction of cold ischaemia time may in part explain the improvements in graft survival.

摘要

本综述报告了过去 25 年英国儿科肾移植的结果。对 1992 年 1 月 1 日至 2016 年 12 月 31 日期间进行的 3236 例儿科肾移植的英国移植登记处数据进行了分析。人类白细胞抗原（HLA）匹配方面取得了显著进展；2016 年，84%的受者接受了 000 或有利（0DR 和 0 或 1B）错配肾脏，而 1992 年为 27%。中位等待时间从 1999 年的 126 天增加到 2016 年的 351 天。他克莫司在 2002 年后取代环孢素成为大多数免疫抑制方案中的主要药物。肾移植结果显著改善，主要是由于早期移植物丢失减少。2012 年至 2016 年脑死亡后供体肾移植的 1 年存活率为 98%，而 1987 年至 1991 年的 1 年存活率为 72%。首次单肾移植 1、5、10、20 和 25 年的肾存活率分别为 89%、79%、65%、42%和 33%。整个研究期间，活体供者的存活率更高，25 年移植物存活率为 33%，而尸肾供者为 31%（P<0.0001）。免疫抑制方案的改变、HLA 匹配的提高和冷缺血时间的减少可能部分解释了移植物存活率的提高。