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美国循环死亡供者肾移植的当代存活模式。

Contemporary patterns in kidney graft survival from donors after circulatory death in the United States.

机构信息

Division of Nephrology, Department of Medicine, University of Washington, Seattle, WA, United States of America.

Division of Transplant Surgery, Department of Surgery, University of Washington, Seattle, WA, United States of America.

出版信息

PLoS One. 2020 May 29;15(5):e0233610. doi: 10.1371/journal.pone.0233610. eCollection 2020.

Abstract

BACKGROUND

Kidney transplants from donors after circulatory death (DCD) make up an increasing proportion of all deceased donor kidney transplants in the United States (US). However, DCD grafts are considered to be of lower quality than kidneys from donors after brain death (DBD). It is unclear whether graft survival is different for these two types of donor kidneys.

MATERIALS AND METHODS

We conducted a retrospective cohort study of US deceased donor kidney recipients using data from the United Network of Organ Sharing from 12/4/2014 to 6/30/2018. We employed a Cox proportional hazard model with mixed effects to compare all-cause graft loss and death-censored graft loss for DCD versus DBD deceased donor kidney transplant recipients. We used transplant center as the random effects term to account for cluster-specific random effects. In the multivariable analysis, we adjusted for recipient characteristics, donor factors, and transplant logistics.

RESULTS

Our cohort included 27,494 DBD and 7,770 DCD graft recipients transplanted from 2014 to 2018 who were followed over a median of 1.92 years (IQR 1.08-2.83). For DCD compared with DBD recipients, we did not find a significant difference in all-cause graft loss (hazard ratio [HR] 0.96, 95% confidence interval [CI] 0.87-1.05 in univariable and HR 1.03 [95% CI 0.95-1.13] in multivariable analysis) or for death-censored graft loss (HR 0.97 (95% CI 0.91-1.06) in univariable and 1.05 (95% CI 0.99-1.11) in multivariable analysis).

CONCLUSIONS

For a contemporary cohort of deceased donor kidney transplant recipients, we did not find a difference in the likelihood of graft loss for DCD compared with DBD grafts. These findings signal a need for additional investigation into whether DCD status independently contributes to other important outcomes for current kidney transplant recipients and indices of graft quality.

摘要

背景

在美国,来自循环死亡供体(DCD)的肾脏移植在所有已故供体肾脏移植中的比例不断增加。然而,与脑死亡供体(DBD)的肾脏相比,DCD 移植物的质量被认为较低。目前尚不清楚这两种供体肾脏的移植物存活率是否不同。

材料和方法

我们使用来自美国器官共享网络的数据,对 2014 年 12 月 4 日至 2018 年 6 月 30 日期间接受美国已故供体肾脏受体的回顾性队列研究进行了回顾性队列研究。我们采用混合效应 Cox 比例风险模型比较了 DCD 与 DBD 已故供体肾移植受体的全因移植物丢失和死亡censored 移植物丢失。我们使用移植中心作为随机效应项,以解释特定于簇的随机效应。在多变量分析中,我们调整了受体特征、供体因素和移植物流。

结果

我们的队列包括 2014 年至 2018 年期间接受移植的 27494 名 DBD 和 7770 名 DCD 移植物受体,中位随访时间为 1.92 年(IQR 1.08-2.83)。与 DBD 受体相比,我们没有发现全因移植物丢失(单变量 HR 0.96,95%CI 0.87-1.05;多变量 HR 1.03 [95%CI 0.95-1.13])或死亡 censored 移植物丢失(单变量 HR 0.97(95%CI 0.91-1.06)和多变量 HR 1.05(95%CI 0.99-1.11))之间存在显著差异。

结论

对于当代已故供体肾脏移植受体队列,我们没有发现 DCD 与 DBD 移植物丢失的可能性存在差异。这些发现表明,需要进一步研究 DCD 状态是否独立影响当前肾脏移植受体的其他重要结果和移植物质量指标。

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