Shofer F S, London W T, Lyons P, Simonian S J, Burke J F, Jarrell B E, Grossman R A, Barker C F
Transplantation. 1986 Nov;42(5):473-8. doi: 10.1097/00007890-198611000-00006.
Risk factors associated with death were identified in a cohort of patients who received 2 or more kidney transplants. Data on 19 variables were collected by chart review on 774 patients who received allografts between 1973 and 1980 at any one of 3 hospitals in Philadelphia. 124 of the patients received two or more transplants and were followed for a minimum of 1.5 years. Modified life table analyses of single variables indicated that 7 factors--splenectomy, donor source, age, transplant hospital, number of HLA mismatches, donor sex, and survival time of the prior graft--were significantly related to patient survival. Using all 19 variables, the proportional hazards model was fit to the data. The characteristics most related to survival were splenectomy (P less than .001), donor source (P = .0022), and age (P = .0015). The other 4 factors that were significant on univariate analysis were not significant in this multivariate analysis. The relative risk of death was 5.5 for patients who had had a splenectomy compared with those who had not had a splenectomy. Patients who had received more than one transplant were compared with patients who had received only one transplant, and a subset of recipients of primary transplants who returned to dialysis after primary graft failure. Survival of patients who had received one transplant was approximately the same as that of the retransplanted population. When the proportional hazards model was fit to the populations that received one transplant and compared with the model for the retransplanted group, only age and donor source were common to all three models. The effect of splenectomy on survival was significant for the total population of primary transplant recipients but had no effect on the survival of the subset of recipients whose kidney grafts had failed and were returned to hemodialysis. Infection accounted for 45% of the deaths among splenectomized, retransplanted patients. A higher percentage of septic deaths occurred in patients whose grafts were functioning at the time of death when compared with patients who had returned to dialysis after secondary graft failure. Although retransplantation alone is not associated with an increased mortality, retransplantation in splenectomized patients carries a high risk of death.
在一组接受过两次或更多次肾移植的患者中确定了与死亡相关的危险因素。通过查阅病历，收集了1973年至1980年间在费城3家医院中任何一家接受同种异体移植的774例患者的19项变量数据。其中124例患者接受了两次或更多次移植，并至少随访了1.5年。对单个变量进行的改良寿命表分析表明，脾切除术、供体来源、年龄、移植医院、HLA错配数、供体性别以及先前移植的存活时间这7个因素与患者存活显著相关。使用所有19项变量，将比例风险模型应用于这些数据。与存活最相关的特征是脾切除术（P<0.001）、供体来源（P = 0.0022）和年龄（P = 0.0015）。单变量分析中有显著意义的其他4个因素在该多变量分析中无显著意义。与未进行脾切除术的患者相比，进行过脾切除术的患者死亡相对风险为5.5。将接受过不止一次移植的患者与仅接受过一次移植的患者进行比较，以及将初次移植失败后恢复透析的初次移植受者子集进行比较。接受过一次移植的患者的存活率与再次移植人群的存活率大致相同。当将比例风险模型应用于接受一次移植的人群并与再次移植组的模型进行比较时，所有三个模型共有的因素只有年龄和供体来源。脾切除术对初次移植受者总体人群的存活有显著影响，但对肾移植失败并恢复血液透析的受者子集的存活没有影响。在接受过脾切除术的再次移植患者中，感染占死亡原因的45%。与二次移植失败后恢复透析的患者相比，移植在死亡时仍在发挥功能的患者中败血症死亡的比例更高。虽然单纯再次移植与死亡率增加无关，但脾切除术后再次移植的患者死亡风险很高。
