Schwager Ysabell, Littbarski Simon Alexander, Nolte Almut, Kaltenborn Alexander, Emmanouilidis Nikos, Kleine-Döpke Dennis, Klempnauer Jürgen, Schrem Harald
Core Facility Quality Management and Health Technology Assessment in Transplantation, Integrated Research and Treatment Facility Transplantation (IFB-Tx), Hannover Medical School, Hannover, Germany.
Department of General, Visceral and Transplant Surgery, Hannover Medical School, Hannover, Germany.
Ann Transplant. 2019 May 17;24:273-290. doi: 10.12659/AOT.913217.
BACKGROUND Prognostic models for 3-year mortality after kidney transplantation based on pre-transplant donor and recipient variables may avoid futility and thus improve donor organ allocation. MATERIAL AND METHODS There were 1546 consecutive deceased-donor kidney transplants in adults (January 1, 2000 to December 31, 2012) used to identify pre-transplant donor and recipient variables with significant independent influence on long-term survival (Cox regression modelling). Detected factors were used to develop a prognostic model for 3-year mortality in 1289 patients with follow-up of >3 years (multivariable logistic regression). The sensitivity and specificity of this model's prognostic ability was assessed with the area under the receiver operating characteristic curve (AUROC). RESULTS Highly immunized recipients [hazard ratio (HR: 2.579, 95% CI: 1.272-4.631], high urgency recipients (HR: 3.062, 95% CI: 1.294-6.082), recipients with diabetic nephropathy (HR: 3.471, 95% CI: 2.476-4.751), as well as 0, 1, or 2 HLA DR mismatches (HR: 1.349, 95% CI: 1.160-1.569) were independent and significant risk factors for patient survival. Younger recipient age ≤42.1 years (HR: 0.137, 95% CI: 0.090-0.203), recipient age 42.2-52.8 years (HR: 0.374, 95% CI: 0.278-0.498), recipient age 52.9-62.8 years (HR: 0.553, 95% CI: 0.421-0.723), short cold ischemic times ≤11.8 hours (HR: 0.602, 95% CI: 0.438-0.814) and cold ischemic times 11.9-15.3 hours (HR: 0.736, 95% CI: 0.557-0.962) reduced this risk independently and significantly. The AUROC of the derived model for 3-year post-transplant mortality with these variables was 0.748 (95% CI: 0.689-0.788). CONCLUSIONS Older, highly immunized or high urgency transplant candidates with anticipated longer cold ischemic times, who were transplanted with the indication of diabetic nephropathy should receive donor organs with no HLA DR mismatches to improve their mortality risk.
基于移植前供体和受体变量的肾移植后3年死亡率预后模型可避免无效治疗，从而改善供体器官分配。材料与方法：对2000年1月1日至2012年12月31日期间1546例成人连续的尸体供肾移植进行研究，以确定对长期生存有显著独立影响的移植前供体和受体变量（Cox回归模型）。检测到的因素用于为1289例随访时间>3年的患者建立3年死亡率预后模型（多变量逻辑回归）。用受试者工作特征曲线下面积（AUROC）评估该模型预后能力的敏感性和特异性。结果：高敏受者[风险比（HR）：2.579，95%置信区间（CI）：1.272 - 4.631]、高紧急度受者（HR：3.062，95% CI：1.294 - 6.082）、糖尿病肾病受者（HR：3.471，95% CI：2.476 - 4.751）以及0、1或2个HLA DR错配（HR：1.349，95% CI：1.160 - 1.569）是患者生存的独立且显著的危险因素。年龄≤42.1岁的年轻受者（HR：0.137，95% CI：0.090 - 0.203）、年龄42.2 - 52.8岁的受者（HR：0.374，95% CI：0.278 - 0.498）、年龄52.9 - 62.8岁的受者（HR：0.553，95% CI：0.421 - 0.723）、冷缺血时间≤11.8小时（HR：0.602，95% CI：0.438 - 0.814）以及冷缺血时间11.9 - 15.3小时（HR：0.736，95% CI：(0.557 - 0.962)）可独立且显著降低这种风险。利用这些变量得出的移植后3年死亡率模型的AUROC为0.748（95% CI：0.689 - 0.788）。结论：年龄较大、高敏或高紧急度的移植候选者，预期冷缺血时间较长，且因糖尿病肾病而接受移植，应接受无HLA DR错配的供体器官，以改善其死亡风险。
