Parajuli Sandesh, Swanson Kurtis J, Patel Ravi, Astor Brad C, Aziz Fahad, Garg Neetika, Mohamed Maha, Al-Qaoud Talal, Redfield Robert, Djamali Arjang, Kaufman Dixon, Odorico Jon, Mandelbrot Didier A
Division of Nephrology, Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA.
Department of Population Health Sciences, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA.
Transpl Int. 2020 Sep;33(9):1106-1115. doi: 10.1111/tri.13665. Epub 2020 Jun 18.
Among kidney transplant recipients, the duration of pretransplant dialysis is significantly associated with worse post-transplant outcomes. However, data on the outcomes of preemptive simultaneous pancreas and kidney (SPK) are limited. We analyzed primary SPK recipients transplanted between January 2000 and December 2017. Patients were divided into two groups based on pretransplant dialysis history of preemptive versus non-preemptive. Patient and survival of grafts were outcomes of interest. Of the 644 recipients, 174 (27%) were preemptive and 470 (73%) were not. Most of the baseline characteristics were similar between the groups. In the univariable analysis, the non-preemptive transplant was associated with 54% increased risk for kidney death-censored graft failure (DCGF; HR: 1.54; 95% CI: 1.01-2.35; P = 0.05). There was a 29% increased risk after adjustment for confounding factors (HR: 1.29; 95% CI: 0.83-2.02; P = 0.26), although this association was not statistically significant. Similarly, there was a 16% increased risk of pancreas DCGF in univariable analysis and 1% after adjustment, which was also not statistically significant. When outcomes were based on the duration of pretransplant dialysis, the duration was not associated with either patient survival or survival of either graft in K-M analysis. In SPK recipients, with pretransplant dialysis history, there was a tendency toward inferior graft survival, mainly for the kidney more than the pancreas.
在肾移植受者中，移植前透析的持续时间与移植后较差的结局显著相关。然而，关于抢先性同期胰肾联合移植（SPK）结局的数据有限。我们分析了2000年1月至2017年12月期间接受初次SPK移植的受者。根据移植前是否进行抢先性透析的病史将患者分为两组。患者和移植物的存活情况是关注的结局。在644名受者中，174名（27%）为抢先性透析，470名（73%）不是。两组之间的大多数基线特征相似。在单变量分析中，非抢先性移植与肾死亡截尾移植物失败（DCGF）风险增加54%相关（HR：1.54；95%CI：1.01-2.35；P = 0.05）。在调整混杂因素后，风险增加29%（HR：1.29；95%CI：0.83-2.02；P = 0.26），尽管这种关联无统计学意义。同样，在单变量分析中，胰腺DCGF风险增加16%，调整后增加1%，也无统计学意义。当结局基于移植前透析的持续时间时，在K-M分析中，该持续时间与患者存活或任何一种移植物的存活均无关。在有移植前透析病史的SPK受者中，移植物存活有较差的趋势，主要是肾脏而非胰腺。
