Nephrology and Kidney Transplant Department, Hospital Clínic de Barcelona, Barcelona, Spain; Laboratori Experimental de Nefrologia I Trasplantament (LENIT), Fundació Clínic per a la Recerca Biomèdica (FCRB), Barcelona, Spain.
Nephrology and Kidney Transplant Department, Hospital Clínic de Barcelona, Barcelona, Spain.
Kidney Int. 2022 Aug;102(2):421-430. doi: 10.1016/j.kint.2022.04.032. Epub 2022 May 27.
Several organ allocation protocols give priority to wait-listed simultaneous kidney-pancreas (SPK) transplant recipients to mitigate the higher cardiovascular risk of patients with diabetes mellitus on dialysis. The available information regarding the impact of preemptive simultaneous kidney-pancreas transplantation on recipient and graft outcomes is nonetheless controversial. To help resolve this, we explored the influence of preemptive simultaneous kidney-pancreas transplants on patient and graft survival through a retrospective analysis of the OPTN/UNOS database, encompassing 9690 simultaneous transplant recipients between 2000 and 2017. Statistical analysis was performed applying a propensity score analysis to minimize bias. Of these patients, 1796 (19%) were transplanted preemptively. At ten years, recipient survival was significantly superior in the preemptive group when compared to the non-preemptive group (78.9% vs 71.8%). Dialysis at simultaneous kidney-pancreas transplantation was an independent significant risk for patient survival (hazard ratio 1.66 [95% confidence interval 1.32-2.09]), especially if the dialysis duration was 12 months or longer. Preemptive transplantation was also associated with significant superior kidney graft survival compared to those on dialysis (death-censored: 84.3% vs 75.4%, respectively; estimated half-life of 38.57 [38.33 -38.81] vs 22.35 [22.17 - 22.53] years, respectively). No differences were observed between both groups neither for pancreas graft survival nor for post-transplant surgical complications. Thus, our results sustain the relevance of early referral for pancreas transplantation and the importance of pancreas allocation priority in reducing patient mortality after simultaneous kidney-pancreas transplantation.
几种器官分配方案优先考虑同时进行肾胰（SPK）移植的候补患者，以降低透析糖尿病患者的心血管风险。然而，关于抢先进行同时肾胰移植对受者和移植物结局的影响的现有信息仍存在争议。为了帮助解决这一问题，我们通过对 OPTN/UNOS 数据库（涵盖 2000 年至 2017 年期间的 9690 例同时移植受者）进行回顾性分析，探讨了抢先进行同时肾胰移植对患者和移植物存活率的影响。我们应用倾向评分分析来最小化偏倚进行统计分析。在这些患者中，1796 例（19%）是抢先移植的。在 10 年时，与非抢先组相比，抢先组的受者存活率显著更高（78.9%对 71.8%）。同时进行肾胰移植时进行透析是患者存活率的独立显著风险因素（风险比 1.66 [95%置信区间 1.32-2.09]），尤其是如果透析时间为 12 个月或更长时间。与透析患者相比，抢先移植也与显著更高的肾移植物存活率相关（死亡校正：分别为 84.3%和 75.4%；估计半衰期分别为 38.57 [38.33-38.81]和 22.35 [22.17-22.53]年）。两组之间在胰腺移植物存活率或移植后手术并发症方面均无差异。因此，我们的结果支持早期转介进行胰腺移植的相关性以及在降低同时肾胰移植后患者死亡率方面胰腺分配优先级的重要性。
