高肾脏供者评分指数供肾的预先移植获益。

The Benefits of Preemptive Transplantation Using High-Kidney Donor Profile Index Kidneys.

机构信息

Kidney Transplant Program, Division of Nephrology, University of British Columbia, Vancouver, British Columbia, Canada.

Vancouver Coastal Health Research Institute, Vancouver, British Columbia, Canada.

出版信息

Clin J Am Soc Nephrol. 2023 May 1;18(5):634-643. doi: 10.2215/CJN.0000000000000134. Epub 2023 Apr 7.

DOI:10.2215/CJN.0000000000000134

PMID:37027505

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC10278842/

Abstract

BACKGROUND

The Kidney Donor Profile Index (KDPI) is a percentile score summarizing the likelihood of allograft failure: A KDPI ≥85% is associated with shorter allograft survival, and 50% of these donated kidneys are not currently used for transplantation. Preemptive transplantation (transplantation without prior maintenance dialysis) is associated with longer allograft survival than transplantation after dialysis; however, it is unknown whether this benefit extends to high-KDPI transplants. The objective of this analysis was to determine whether the benefit of preemptive transplantation extends to recipients of transplants with a KDPI ≥85%.

METHODS

This retrospective cohort study compared the post-transplant outcomes of preemptive and nonpreemptive deceased donor kidney transplants using data from the Scientific Registry of Transplant Recipients. 120,091 patients who received their first, kidney-only transplant between January 1, 2005, and December 31, 2017, were studied, including 23,211 with KDPI ≥85%. Of this cohort, 12,331 patients received a transplant preemptively. Time-to-event models for the outcomes of allograft loss from any cause, death-censored graft loss, and death with a functioning transplant were performed.

RESULTS

Compared with recipients of nonpreemptive transplants with a KDPI of 0%-20% as the reference group, the risk of allograft loss from any cause in recipients of a preemptive transplant with KDPI ≥85% (hazard ratio [HR], 1.51; 95% confidence interval [CI], 1.39 to 1.64) was lower than that in recipients of nonpreemptive transplant with a KDPI ≥85% (HR, 2.39; 95% CI, 2.21 to 2.58) and similar to that of recipients of a nonpreemptive transplant with a KDPI of 51%-84% (HR, 1.61; 95% CI, 1.52 to 1.70).

CONCLUSIONS

Preemptive transplantation is associated with a lower risk of allograft failure, irrespective of KDPI, and preemptive transplants with KDPI ≥85% have comparable outcomes with nonpreemptive transplants with KDPI 51%-84%.

摘要

背景

肾脏供体评分指数（KDPI）是一个百分位数评分，用于总结同种异体移植物失败的可能性：KDPI≥85%与移植物存活率缩短有关，其中 50%的供肾目前未用于移植。抢先移植（在不进行维持性透析之前进行的移植）与透析后移植相比，移植物存活率更长；然而，尚不清楚这种益处是否扩展到高 KDPI 移植。本分析的目的是确定抢先移植的益处是否扩展到 KDPI≥85%的移植受者。

方法

本回顾性队列研究使用移植受者登记处的数据比较了抢先和非抢先死亡供体肾移植的移植后结局。研究了 2005 年 1 月 1 日至 2017 年 12 月 31 日期间接受首次单肾移植的 120091 名患者，包括 KDPI≥85%的 23211 名患者。在此队列中，12331 名患者接受了抢先移植。进行了所有原因移植物丢失、死亡校正移植物丢失和有功能移植物死亡的时间事件模型。

结果

与 KDPI 为 0%-20%的非抢先移植受者相比，KDPI≥85%的抢先移植受者的任何原因移植物丢失风险（危险比[HR]，1.51；95%置信区间[CI]，1.39 至 1.64）低于 KDPI≥85%的非抢先移植受者（HR，2.39；95%CI，2.21 至 2.58），与 KDPI 为 51%-84%的非抢先移植受者相似（HR，1.61；95%CI，1.52 至 1.70）。