澳大利亚和新西兰的肝肾联合移植的趋势和结果。

Trends and Outcomes in Simultaneous Liver and Kidney Transplantation in Australia and New Zealand.

机构信息

National Health and Medical Research Council Clinical Trials Centre, University of Sydney, Sydney, New South Wales, Australia.

Nephrology Department, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia.

出版信息

Transplant Proc. 2021 Jan-Feb;53(1):136-140. doi: 10.1016/j.transproceed.2020.08.030. Epub 2020 Sep 12.

DOI:10.1016/j.transproceed.2020.08.030

PMID:32933766

Abstract

AIM

Rates of simultaneous liver and kidney transplantation (SLKT) have increased, but indications for SLKT remain poorly defined. Additional data are needed to determine which patients benefit from SLKT to best direct use of scarce donor kidneys.

METHODS

Data were extracted from the Australia and New Zealand Dialysis and Transplant Registry (ANZDATA) database for all SLKT performed until the end of 2017. Patients were divided by pretransplant dialysis status into no dialysis before SLKT (preemptive kidney transplant) and any dialysis before SLKT (nonpreemptive). Baseline characteristics and outcomes were compared.

RESULTS

Between 1989 and 2017, inclusive, 84 SLKT procedures were performed in Australia, of which 24% were preemptive. Preemptive and nonpreemptive SLKT recipients did not significantly differ in age (P = .267), sex (P = .526), or ethnicity (P = .870). Over a median follow-up time of 4.5 years, preemptively transplanted patients had a statistically equivalent risk of kidney graft failure (hazard ratio (HR) 1.83, 95% confidence interval [CI]: 0.36-12.86, P = .474) and all-cause mortality (HR 1.69, 95% CI: 0.51-5.6, P = .226) compared to nonpreemptive patients. Overall, 1- and 5-year survival rates for all SLKTs were 92% (95% CI: 86-96) and 60% (95% CI: 45-75), respectively.

CONCLUSION

Kidney graft and overall patient survival were similar between patients with preemptive kidney transplant and those who were dialysis dependent.

摘要

目的

肝肾联合移植（SLKT）的比例有所增加，但 SLKT 的适应证仍未明确界定。需要更多的数据来确定哪些患者从 SLKT 中受益，以便更好地指导稀缺供肾的使用。

方法

从澳大利亚和新西兰透析和移植登记处（ANZDATA）数据库中提取了截至 2017 年底前进行的所有 SLKT 的数据。根据移植前透析状态，患者分为 SLKT 前无需透析（抢先肾移植）和 SLKT 前有透析（非抢先）。比较了两组患者的基线特征和结局。

结果

1989 年至 2017 年期间，澳大利亚共进行了 84 例 SLKT，其中 24%为抢先。抢先和非抢先 SLKT 受者在年龄（P=0.267）、性别（P=0.526）或种族（P=0.870）方面无显著差异。中位随访时间为 4.5 年，抢先移植患者的肾移植失败风险具有统计学等效性（风险比[HR] 1.83，95%置信区间[CI]：0.36-12.86，P=0.474）和全因死亡率（HR 1.69，95% CI：0.51-5.6，P=0.226）与非抢先患者相比。总体而言，所有 SLKT 的 1 年和 5 年生存率分别为 92%（95%CI：86-96）和 60%（95%CI：45-75）。