机器人辅助与传统开放性肾移植：倾向匹配比较及5年中位随访
Robot-assisted versus conventional open kidney transplantation: a propensity matched comparison with median follow-up of 5 years.
作者信息
Patil Abhijit, Ganpule Arvind, Singh Abhishek, Agrawal Anshul, Patel Pratik, Shete Nitiraj, Sabnis Ravindra, Desai Mahesh
机构信息
Department of Urology, Muljibhai Patel Urological Hospital Nadiad, India.
Department of Biostatistics, Muljibhai Patel Urological Hospital Nadiad, India.
出版信息
Am J Clin Exp Urol. 2023 Apr 15;11(2):168-176. eCollection 2023.
BACKGROUND
RAKT is a relatively newer approach for kidney transplant and has to be proven against the established approach, OKT. RAKT may be beneficial in obese patients as described in literature. Hence, we compared pre-, intra- and postoperative parameters with one year follow-up of both approaches by propensity matching similar characteristics patients.
METHODS
Data of 28 OKT and 28 RAKT propensity matched patients was collected during 2014 to 2022 through the institutional transplant registry. OKT and RAKT patients were propensity matched for confounding factors like donor age, eGFR, side along with recipient age, BMI and comorbidities. All graft kidneys were harvested laparoscopically.
RESULTS
Both the groups were comparable in terms of recipient age and BMI, donor age, creatinine, BMI, eGFR and comorbidities. Total ischemia time (P<0.001) and postoperative day (POD) 1 creatinine (P<0.001) was significantly more in RAKT. However, postoperative 1 month (P=0.12), 3 months (P=0.60) and 1 year (P=0.10) creatinine was comparable in both approaches. Postoperative complications (P=0.90) including hemoglobin drop (P=0.72) were comparable in both the groups. The days to half the creatinine from preoperative values was significantly less in OKT group (P=0.009). Serum Tacrolimus levels at day 3 (P=0.08) and day 7 (P=0.112) were also comparable in both the groups. Graft survival was 78.5% in OKT group and 82.14% in RAKT group with median follow-up of 60 months in both the groups.
CONCLUSION
In this comprehensive propensity matched analysis of RAKT with OKT, we conclude that RAKT has similar outcomes as OKT at 1 year and 5 years follow-up. CIT, TIT, time to half creatinine and POD 1 creatinine values were higher in RAKT group, but eventually have comparable outcomes at further follow-up. Thus, RAKT, a novel approach is non-inferior to established OKT approach. However, further larger trials are required.
背景
肾自动移植术（RAKT）是一种相对较新的肾移植方法，必须与已确立的开放肾移植术（OKT）进行对比验证。如文献所述，RAKT可能对肥胖患者有益。因此，我们通过倾向得分匹配具有相似特征的患者，比较了两种方法术前、术中和术后的参数以及一年的随访情况。
方法
2014年至2022年期间，通过机构移植登记处收集了28例OKT患者和28例倾向得分匹配的RAKT患者的数据。OKT组和RAKT组在供体年龄、估算肾小球滤过率（eGFR）、肾侧别以及受体年龄、体重指数（BMI）和合并症等混杂因素方面进行了倾向得分匹配。所有移植肾均通过腹腔镜获取。
结果
两组在受体年龄和BMI、供体年龄、肌酐、BMI、eGFR和合并症方面具有可比性。RAKT组的总缺血时间（P<0.001）和术后第1天肌酐水平（P<0.001）显著更高。然而，两种方法术后1个月（P=0.12）、3个月（P=0.60）和1年（P=0.10）的肌酐水平相当。两组术后并发症（P=0.90），包括血红蛋白下降（P=0.72）情况相当。OKT组肌酐从术前值降至一半所需的天数显著更少（P=0.009）。两组术后第3天（P=0.08）和第7天（他克莫司）血清水平（P=0.112）也相当。OKT组的移植物存活率为78.5%，RAKT组为82.14%，两组的中位随访时间均为60个月。
结论
在这项对RAKT与OKT进行的全面倾向得分匹配分析中，我们得出结论，在1年和5年随访时，RAKT与OKT的结果相似。RAKT组的冷缺血时间、温缺血时间、肌酐降至一半所需时间和术后第1天肌酐值更高，但在进一步随访中最终结果相当。因此，RAKT这种新方法不劣于已确立的OKT方法。然而，需要进一步开展更大规模的试验。
Zotero 插件