Division of Nephrology, McMaster University, Hamilton, ON, Canada.
ICES, London, ON, Canada.
Transplantation. 2020 Nov;104(11):e317-e327. doi: 10.1097/TP.0000000000003337.
Consider a theoretical situation in which 2 patients with similar baseline characteristics receive a kidney transplant on the same day: 1 from a standard criteria deceased donor, the other from a living donor. Which kidney transplant will last longer?
We conducted a population-based cohort study using linked administrative healthcare databases from Ontario, Canada, from January 1, 2005, to March 31, 2014, to evaluate several posttransplant outcomes in individuals who received a kidney transplant from a standard criteria deceased donor (n = 1523) or from a living donor (n = 1373). We used PS weighting using overlap weights, a novel weighting method that emphasizes the population of recipients with the most overlap in baseline characteristics.
Compared with recipients of a living donor, the rate of all-cause graft failure was not statistically higher for recipients of a standard criteria deceased donor (hazard ratio, 1.1; 95% confidence interval [CI], 0.8-1.6). Recipients of a standard criteria deceased donor, compared with recipients of a living donor had a higher rate of delayed graft function (23.6% versus 18.7%; odds ratio, 1.3; 95% CI, 1.0-1.6) and a longer length of stay for the kidney transplant surgery (mean difference, 1.7 d; 95% CI, 0.5-3.0).
After accounting for many important donor and recipient factors, we failed to observe a large difference in the risk of all-cause graft failure for recipients of a standard criteria deceased versus living donor. Some estimates were imprecise, which meant we could not rule out the presence of smaller clinically important effects.
试想一种理论情况，两名基线特征相似的患者在同一天接受肾移植：一名来自标准供体的已故供者，另一名来自活体供者。哪次移植的肾会持续更长时间？
我们开展了一项基于人群的队列研究，使用来自加拿大安大略省的基于人群的队列研究，使用链接的行政医疗保健数据库，从 2005 年 1 月 1 日至 2014 年 3 月 31 日，评估从标准供体已故供者（n=1523）或活体供者（n=1373）接受肾移植的个体的几种移植后结局。我们使用重叠权重的 PS 加权，这是一种新的加权方法，强调在基线特征最相似的受者人群中。
与活体供者受者相比，标准供体已故供者受者的全因移植物失功率无统计学差异（风险比，1.1；95%置信区间[CI]，0.8-1.6）。与活体供者受者相比，标准供体已故供者受者的延迟移植物功能发生率更高（23.6%比 18.7%；优势比，1.3；95%CI，1.0-1.6），且肾移植手术的住院时间更长（平均差值，1.7 d；95%CI，0.5-3.0）。
在考虑了许多重要的供者和受者因素后，我们未能观察到标准供体已故供者与活体供者受者全因移植物失功风险的显著差异。一些估计值不够精确，这意味着我们不能排除存在较小的临床重要影响。
