活体供肾肾移植后次优肾脏的长期移植肾存活情况较差。

Inferior Long-Term Graft Survival of Suboptimal Kidneys After Living Donor Kidney Transplantation.

作者信息

Yamanaga Shigeyoshi, Freise Chris E, Stock Peter G, Rosario Angel, Fernandez Danny, Kobayashi Takaaki, Tavakol Mehdi, Kang Sang-Mo

机构信息

Division of Transplant Surgery, Department of Surgery, University of California, San Francisco, San Francisco, CA; Department of Surgery, Japanese Red Cross Kumamoto Hospital, Kumamoto, Japan; Department of Renal Transplant Surgery, Aichi Medical University School of Medicine, Nagakute, Japan.

Division of Transplant Surgery, Department of Surgery, University of California, San Francisco, San Francisco, CA.

出版信息

Transplant Proc. 2020 Jul-Aug;52(6):1734-1740. doi: 10.1016/j.transproceed.2020.01.151. Epub 2020 May 20.

DOI:10.1016/j.transproceed.2020.01.151

PMID:32446691

Abstract

BACKGROUND

In living donors, if both kidneys are considered to be of equal quality, the side with favorable anatomy for transplant is usually selected. A "suboptimal kidney" is a kidney that has a significant abnormality and is chosen to maintain the principle of leaving the better kidney with the donor. We hypothesized that the long-term outcome of suboptimal kidney is inferior to that of the normal kidney.

METHODS

In a retrospective analysis of 1744 living donor kidney transplantations performed between 1999 and 2015 at our institution, 172 allografts were considered as a suboptimal kidney (9.9%). Median length of follow-up after living donor kidney transplantation was 59.5 months (interquartile range 26.3-100.8). This study strictly complied with the Helsinki Congress and the Istanbul Declaration regarding donor source.

RESULTS

The reasons for suboptimal kidneys were cysts or tumors (46.5%), arterial abnormalities (22.7%), inferior size or function (19.8%), and anatomic abnormalities (11.0%). Suboptimal kidneys showed worse long-term overall graft survival regardless of the reasons (5-year: control vs suboptimal kidney; 88.9% vs 79.3%, P = .001 and 10-year: 73.6% vs 63.5%, P = .004). Suboptimal kidneys showed a 1.6-fold higher adjusted hazard ratio (aHR) of all-cause graft loss (95% confidence interval [CI]: 1.1-2.5, P = .025) and had the same impact as older donor age (≥ 54 years old, aHR: 1.6, 95% CI: 1.1-2.4, P = .008).

CONCLUSIONS

The impact of suboptimal kidney should be factored into the donor selection process.

摘要

背景

在活体供体中，如果两个肾脏质量相当，通常会选择解剖结构有利于移植的一侧肾脏。“次优肾脏”是指存在明显异常的肾脏，选择它是为了遵循给供体保留更好肾脏的原则。我们假设次优肾脏的长期预后不如正常肾脏。

方法

对1999年至2015年在我们机构进行的1744例活体供肾移植进行回顾性分析，其中172例同种异体移植被视为次优肾脏（9.9%）。活体供肾移植后的中位随访时间为59.5个月（四分位间距26.3 - 100.8）。本研究严格遵循关于供体来源的赫尔辛基大会和伊斯坦布尔宣言。

结果

次优肾脏的原因包括囊肿或肿瘤（46.5%）、动脉异常（22.7%）、体积或功能欠佳（19.8%）以及解剖异常（11.0%）。无论原因如何，次优肾脏的长期总体移植存活率均较差（5年：对照组与次优肾脏；88.9%对79.3%，P = 0.001；10年：73.6%对63.5%，P = 0.004）。次优肾脏的全因移植丢失调整风险比（aHR）高1.6倍（95%置信区间[CI]：1.1 - 2.5，P = 0.025），与供体年龄较大（≥54岁，aHR：1.6，95%CI：1.1 - 2.4，P = 0.008）的影响相同。