Mukherjee Debabrata, Nair Ranjith K, Sharma Sourabh, Datt Bhaskar, Rao Ananth, Prakash Sudeep
Senior Advisor (Nephrology), Army Hospital (Research & Referral), Delhi, India.
Senior Resident (Nephrology), Army Hospital (Research & Referral), Delhi, India.
Med J Armed Forces India. 2020 Jan;76(1):58-62. doi: 10.1016/j.mjafi.2018.08.011. Epub 2018 Nov 22.
Renal transplantation in developing countries like India is largely live donor transplantation. Cadaveric transplantation comprises <2% of all transplants in India.
Ninety-two cadaveric renal transplantations were included. Various donor and recipient characteristics were analysed along with graft and patient survival, using Kaplan-Meier method.
The mean age of the recipients was 35.5 ± 10.9 years while that of cadaver was 43.9 ± 17.0 years. Proportion of females among recipients was 47.8% while that of donors was 34.8%. The most common underlying pathology was chronic glomerulonephritis (44.6%). Antithymocyte globulin was used as induction in 84.8% of cases. Tacrolimus-based triple-drug regimen was most commonly used as maintenance (80.4%). The mean follow-up time was 39.02 ± 28.24 months. The most common cause of death was sepsis (47%). More than 50% deaths (9/17) occurred within first 3 years, while 61.5% of graft loss occurred 5 years after transplantation. The mean graft survival time was 81.6 months (95% confidence interval [CI]: 72.8-90.4). Cumulative proportion of graft survival was 91.6% at 3 years and 77.1% at 5 years. Although females have better mean graft survival time (91.6 vs 73.5 months), it was not a significant difference as shown by log-rank test (p value = 0.062). Pretransplant haemodialysis has no significant effect on graft loss, but patients on peritoneal dialysis have significantly higher odds of graft loss (odds: 4.86, p value < 0.05 [0.018]). The mean patient survival time was 99.5 months (95% CI: 84.0-114.9). Cumulative proportion of patient survival was 83.3% at 3 years and 70.8% at 5 years.
Graft and patient survival rate of cadaveric transplant at our centre was satisfactory. There is need to sensitise and augment the rate of cadaveric transplantation to increase the donor pool.
在印度等发展中国家，肾移植主要是活体供肾移植。尸体供肾移植占印度所有移植手术的比例不到2%。
纳入92例尸体供肾肾移植病例。采用Kaplan-Meier法分析了各种供体和受体特征以及移植物和患者的生存率。
受体的平均年龄为35.5±10.9岁，而尸体供者的平均年龄为43.9±17.0岁。受体中女性比例为47.8%，供体中女性比例为34.8%。最常见的潜在病理是慢性肾小球肾炎（44.6%）。84.8%的病例使用抗胸腺细胞球蛋白进行诱导。以他克莫司为基础的三联药物方案最常用于维持治疗（80.4%）。平均随访时间为39.02±28.24个月。最常见的死亡原因是败血症（47%）。超过50%的死亡（9/17）发生在最初3年内，而61.5%的移植物丢失发生在移植后5年。移植物平均存活时间为81.6个月（95%置信区间[CI]：72.8 - 90.4）。3年时移植物存活的累积比例为91.6%，5年时为77.1%。虽然女性的移植物平均存活时间更长（91.6对73.5个月），但对数秩检验显示差异不显著（p值 = 0.062）。移植前血液透析对移植物丢失无显著影响，但接受腹膜透析的患者移植物丢失的几率显著更高（几率：4.86，p值<0.05[0.018]）。患者平均存活时间为99.5个月（95%CI：84.0 - 114.9）。3年时患者存活的累积比例为83.3%，5年时为70.8%。
我们中心尸体供肾移植的移植物和患者生存率令人满意。需要提高对尸体供肾移植的认识并增加其比例，以扩大供体库。
