Department of Paediatric Nephrology, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK.
Statistics, NHS Blood and Transplant, Bristol, UK.
Arch Dis Child. 2021 Dec;106(12):1191-1194. doi: 10.1136/archdischild-2020-321277. Epub 2021 May 20.
The aim of this study was to investigate whether being on dialysis at the time of renal transplantation affected renal allograft survival in paediatric renal transplant recipients (pRTRs).
Retrospective study of UK Transplant Registry (National Health Service Blood and Transplant) data on all children (aged <18 years) receiving a kidney-only transplant from 1 January 2000 to 31 December 2015. Kaplan-Meier estimates of patient and renal allograft survival calculated and Cox regression modelling accounting for donor type. The relationship between time on dialysis and renal allograft survival was examined.
2038 pRTRs were analysed: 607 (30%) were pre-emptively transplanted, 789 (39%) and 642 (32%) on peritoneal dialysis and haemodialysis, respectively, at the time of transplantation. Five-year renal allograft survival was significantly better in the pre-emptively transplanted group (90.6%) compared with those on peritoneal dialysis and haemodialysis (86.4% and 85.7%, respectively; p=0.02). After accounting for donor type, there was a significantly lower hazard of 5-year renal allograft failure in pre-emptively transplanted children (HR 0.742, p=0.05). Time spent on dialysis pre-transplant negatively correlated with renal allograft survival (p=0.002). There was no significant difference in 5-year renal allograft survival between children who were on dialysis for less than 6 months and children transplanted pre-emptively (87.5% vs 90.5%, p=0.25).
Pre-emptively transplanted children have improved 5-year renal allograft survival, compared with children on dialysis at the time of transplantation. Although increased time spent on dialysis correlated with poorer renal allograft survival, there was no evidence that short periods of dialysis pre-transplant affected renal allograft survival.
本研究旨在探讨肾移植时接受透析治疗是否会影响儿科肾移植受者（pRTR）的肾移植存活。
对英国移植登记处（NHS 血液与移植）2000 年 1 月 1 日至 2015 年 12 月 31 日期间所有接受肾移植的儿童（年龄<18 岁）的数据进行回顾性研究。计算患者和肾移植存活率的 Kaplan-Meier 估计值，并使用 Cox 回归模型进行分析，同时考虑供体类型。检查透析时间与肾移植存活之间的关系。
分析了 2038 名 pRTR：607 名（30%）为预先移植，789 名（39%）和 642 名（32%）在移植时分别进行腹膜透析和血液透析。预先移植组的 5 年肾移植存活率（90.6%）显著优于腹膜透析和血液透析组（分别为 86.4%和 85.7%；p=0.02）。在考虑供体类型后，预先移植儿童的 5 年肾移植失败风险显著降低（HR 0.742，p=0.05）。移植前接受透析的时间与肾移植存活率呈负相关（p=0.002）。移植前接受透析时间少于 6 个月的儿童与预先移植的儿童在 5 年肾移植存活率方面没有显著差异（87.5%比 90.5%，p=0.25）。
与移植时接受透析的儿童相比，预先移植的儿童具有更好的 5 年肾移植存活率。虽然接受透析的时间增加与肾移植存活率较差相关，但没有证据表明移植前短期透析会影响肾移植存活率。
