使用已故供者的肾对评估供者效应对移植结局的影响。
Quantifying Donor Effects on Transplant Outcomes Using Kidney Pairs from Deceased Donors.
机构信息
Department of Biostatistics, University of Washington, Seattle, Washington.
Division of Nephrology, School of Medicine, Johns Hopkins University, Baltimore, Maryland.
出版信息
Clin J Am Soc Nephrol. 2019 Dec 6;14(12):1781-1787. doi: 10.2215/CJN.03810319. Epub 2019 Nov 1.
BACKGROUND AND OBJECTIVES
In kidney transplantation, the relative contribution of donor versus other factors on clinical outcomes is unknown. We sought to quantify overall donor effects on transplant outcomes for kidney donations from deceased donors.
DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: For paired donations from deceased donors resulting in transplants to different recipients, the magnitude of donor effects can be quantified by examining the excess of concordant outcomes within kidney pairs beyond chance concordance. Using data from the Organ Procurement and Transplantation Network between the years 2013 and 2017, we examined concordance measures for delayed graft function, death-censored 1-year graft failure, and death-censored 3-year graft failure. The concordance measures were excess relative risk, excess absolute risk, and the fixation index (where zero is no concordance and one is perfect concordance). We further examined concordance in strata of kidneys with similar values of the Kidney Donor Profile Index, a common metric of organ quality.
RESULTS
If the transplant of the kidney mate resulted in delayed graft function, risk for delayed graft function was 19% higher (95% confidence interval [95% CI], 18% to 20%), or 1.76-fold higher (95% CI, 1.73- to 1.80-fold), than baseline. If a kidney graft failed within 1 year, then the kidney mate's risk of failure was 6% higher (95% CI, 4% to 9%), or 2.85-fold higher (95% CI, 2.25- to 3.48-fold), than baseline. For 3-year graft failure, the excess absolute risk was 7% (95% CI, 4% to 10%) but excess relative risk was smaller, 1.91-fold (95% CI, 1.56- to 2.28-fold). Fixation indices were 0.25 for delayed graft function (95% CI, 0.24 to 0.27), 0.07 for 1-year graft failure (95% CI, 0.04 to 0.09), and 0.07 for 3-year graft failure (95% CI, 0.04 to 0.10). Results were similar in strata of kidneys with a similar Kidney Donor Profile Index.
CONCLUSIONS
Overall results indicated that the donor constitution has small or moderate effect on post-transplant clinical outcomes.
背景和目的
在肾移植中，供体与其他因素对临床结果的相对贡献尚不清楚。我们试图量化供体对来自已故供体的肾移植的移植结局的总体影响。
设计、设置、参与者和测量：对于来自已故供体的配对供体，导致移植给不同受者的情况，可以通过检查配对肾中超出偶然一致的一致结果的程度来量化供体效应的大小。使用 2013 年至 2017 年期间器官获取和移植网络的数据，我们检查了延迟移植物功能、死亡风险校正 1 年移植物失败和死亡风险校正 3 年移植物失败的一致性衡量标准。一致性衡量标准是相对超额风险、绝对超额风险和固定指数（0 表示无一致性，1 表示完全一致）。我们进一步检查了类似肾脏供体特征指数（器官质量的常用指标）值的分层中一致性。
结果
如果移植的肾对侧发生延迟移植物功能，那么发生延迟移植物功能的风险增加 19%（95%置信区间[95%CI]，18%至 20%），或者风险增加 1.76 倍（95%CI，1.73 至 1.80 倍），而基线水平。如果一个肾移植物在 1 年内失败，那么肾对侧的失败风险增加 6%（95%CI，4%至 9%），或者风险增加 2.85 倍（95%CI，2.25 至 3.48 倍），而基线水平。对于 3 年移植物失败，绝对超额风险为 7%（95%CI，4%至 10%），但超额相对风险较小，为 1.91 倍（95%CI，1.56 至 2.28 倍）。固定指数分别为延迟移植物功能的 0.25（95%CI，0.24 至 0.27）、1 年移植物失败的 0.07（95%CI，0.04 至 0.09）和 3 年移植物失败的 0.07（95%CI，0.04 至 0.10）。在类似肾脏供体特征指数的分层中，结果相似。
结论
总体结果表明，供体组成对移植后临床结果有较小或中等影响。
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