Australia and New Zealand Dialysis and Transplant (ANZDATA) Registry, South Australian Health and Medical Research Institute (SAHMRI), Adelaide, SA, Australia.
Department of Renal Medicine, Singapore General Hospital, Singapore, Singapore.
Transpl Int. 2020 Dec;33(12):1667-1680. doi: 10.1111/tri.13681. Epub 2020 Jul 20.
This registry-based study evaluated the contribution of center characteristics to kidney transplant outcomes in adult first kidney transplant recipients in Australia and New Zealand between 2004 and 2014. Primary outcomes were mortality and graft failure, and secondary outcomes were transplant complications. Overall, 6970 transplants from 17 centers were included. For deceased donor transplants, 5-year patient and graft survival rates varied considerably (81.0-93.9% and 72.2-88.3%, respectively). Variations in mortality and graft failure were partially reduced after adjustment for patient characteristics (1% and 20% reductions) and more markedly reduced after adjustment for center characteristics (41% and 55% reductions). For living donor transplants, 5-year patient and graft survival rates varied (89.7-100% and 79.2-96.9%, respectively). Centers with high average total ischemic times (>14 h) were associated with higher mortality for both deceased (adjusted hazard ratio [(AHR] 2.24, 95% CI 1.21-4.13) and living donor transplants (AHR 1.76, 95% CI 1.02-3.04). Small center size (<35 new kidney transplants/year) was associated with a lower hazard of mortality for living donor kidney transplants (AHR 0.48, 95% CI 0.28-0.81). No center characteristic was associated with graft failure. The appreciable variations in deceased donor kidney transplant recipient and graft survival outcomes across centers were attributable to center effects.
这项基于注册的研究评估了中心特征对 2004 年至 2014 年间澳大利亚和新西兰成人首次肾移植受者肾移植结局的影响。主要结局是死亡率和移植物失功，次要结局是移植并发症。共有来自 17 个中心的 6970 例移植纳入研究。对于尸肾移植，5 年患者和移植物存活率差异较大（分别为 81.0%-93.9%和 72.2%-88.3%）。在调整患者特征后，死亡率和移植物失功的差异有所减少（分别减少 1%和 20%），在调整中心特征后减少更为明显（分别减少 41%和 55%）。对于活体供肾移植，5 年患者和移植物存活率有所不同（分别为 89.7%-100%和 79.2%-96.9%）。平均总缺血时间较长（>14 小时）的中心与尸肾（调整后的危险比[HR] 2.24，95%置信区间[CI] 1.21-4.13）和活体供肾移植（调整后的 HR 1.76，95% CI 1.02-3.04）的死亡率升高相关。中心规模较小（<35 例/年新肾移植）与活体供肾移植的死亡率降低相关（调整后的 HR 0.48，95% CI 0.28-0.81）。没有中心特征与移植物失功相关。中心间尸肾移植受者和移植物存活率的显著差异归因于中心效应。
