中低收入国家的肾脏移植：来自亚美尼亚的结果和经验教训。

Kidney Transplantation in Low- to Middle-Income Countries: Outcomes and Lessons Learned from Armenia.

机构信息

Department of Pediatric Surgery and Urology, Arabkir Medical Center - Institute of Child and Adolescent Health, Yerevan, Armenia.

Department of Pediatric Surgery, Yerevan State Medical University after Mkhitar Heratsi, Yerevan, Armenia.

出版信息

Ann Transplant. 2021 Sep 21;26:e930943. doi: 10.12659/AOT.930943.

DOI:10.12659/AOT.930943

PMID:34545060

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC8464179/

Abstract

BACKGROUND Treatment of end-stage renal disease constitutes a heavy financial burden, especially in developing countries. Maintaining a kidney transplantation program is an extremely complex task in countries with limited resources. It often requires expertise and support from developed countries. Living donor kidney transplantations (LDKT) have been performed regularly in the Republic of Armenia since 2002. The purpose of this article is to review the history and outcomes of kidney transplantation in Armenia. MATERIAL AND METHODS A chart review was performed retrospectively on all patients who had undergone LDKT in Armenia. The key personnel involved in the development and operation of the unique kidney transplant program in the country were interviewed for a comprehensive review of the history and challenges of transplantation. RESULTS There were 172 LDKT (4 re-transplantations) performed between 2002 and 2019. The mean age of recipients was 35.9±13.4 years (range 7.1-65.7): 116 (67.4%) were male and 12 (6.9%) were children (<18 years). Seventy-four patients (43%) had peri- (n=5) and postoperative (n=69), mostly mild, surgical complications. Delayed graft function occurred in 17 (9.9%) patients, requiring hemodialysis in 16, and 6 patients stayed HD-dependant. Sixty-nine patients (40.1%) had at least 1 episode of acute rejection, with 26 (15.1%) having more than 1. Late complications were mostly infectious (n=49) or malignant processes (n=13). Follow-up studies showed that out of 172 patients, 126 had functioning grafts, 17 died with functioning grafts, 3 were lost to follow-up, and 26 lost grafts. Graft survival at 1, 3, 5, and 10 years, non-censored for death, after LDKT was 96.4% (CI 93.6-99.2), 93.7% (CI 89.9-97.5), 90.5% (CI 85.7-95.3), and 75.3% (CI 66.9-83.7), respectively. CONCLUSIONS Findings from this study suggest that a renal transplant program with acceptable outcomes can be successfully introduced in countries with limited resources.

摘要

背景

终末期肾病的治疗费用负担沉重，尤其是在发展中国家。在资源有限的国家维持肾脏移植项目是一项极其复杂的任务，往往需要发达国家的专业知识和支持。自 2002 年以来，亚美尼亚共和国一直在定期进行活体供肾移植（LDKT）。本文旨在回顾亚美尼亚的肾脏移植历史和结果。

材料和方法

对 2002 年至 2019 年间在亚美尼亚接受 LDKT 的所有患者进行了回顾性图表审查。对参与该国独特肾脏移植项目发展和运作的关键人员进行了采访，以全面回顾移植的历史和挑战。

结果

共进行了 172 例 LDKT（4 例再次移植）。受者的平均年龄为 35.9±13.4 岁（范围 7.1-65.7）：116 例（67.4%）为男性，12 例（6.9%）为儿童（<18 岁）。74 例（43%）患者发生围手术期（n=5）和术后（n=69）并发症，多为轻度。17 例（9.9%）患者发生延迟移植物功能，16 例需要血液透析，6 例患者依赖血液透析。69 例（40.1%）患者至少发生 1 次急性排斥反应，其中 26 例（15.1%）发生 1 次以上。晚期并发症多为感染（n=49）或恶性病变（n=13）。随访研究显示，在 172 例患者中，126 例移植物功能正常，17 例死亡时移植物功能正常，3 例失访，26 例移植物丢失。LDKT 后 1、3、5 和 10 年的无死亡移植存活率分别为 96.4%（93.6-99.2）、93.7%（89.9-97.5）、90.5%（85.7-95.3）和 75.3%（66.9-83.7）。