Division of Renal Diseases and Hypertension, Department of Medicine, University of Minnesota, Minneapolis, MN, United States.
Complex Care Analytics, MHealth Fairview, Minneapolis, MN, United States.
Transpl Int. 2023 May 5;36:11068. doi: 10.3389/ti.2023.11068. eCollection 2023.
Using the Scientific Registry of Transplant Recipients, we examined the association between donor-recipient biologic relationship and long-term recipient and allograft survival among glomerulonephritis (GN) patients. Four GN types were studied: membranous nephropathy, IgA, lupus-associated nephritis, and focal segmental glomerulosclerosis (FSGS). We identified all adult primary living-donor recipients between 2000 and 2018 ( = 19,668): related ( = 10,437); unrelated ( = 9,231). Kaplan-Meier curves were generated for the recipient, death-censored graft survival and death with functioning graft through ten years post-transplant. Multivariable Cox proportional hazard models were used to examine the association between the donor-recipient relationship and outcomes of interest. There was an increased risk for acute rejection by 12 months post-transplant among the unrelated compared to the related group in IgA (10.1% vs. 6.5%, p<0.001), FSGS (12.1% vs. 10%, -0.016), and lupus nephritis (11.8% vs. 9.2%; -0.049). The biological donor-recipient relationship was not associated with a worse recipient or graft survival or death with functioning graft in the multivariable models. These findings are consistent with the known benefits of living-related-donor kidney transplants and counter the reports of the potential adverse impact of the donor-recipient biologic relationship on allograft outcomes.
利用移植受者科学登记处，我们研究了供体-受者生物学关系与肾小球肾炎（GN）患者长期受者和移植物存活之间的关系。研究了四种 GN 类型：膜性肾病、IgA、狼疮相关性肾炎和局灶节段性肾小球硬化症（FSGS）。我们确定了 2000 年至 2018 年间所有成人原发性活体供者受者（=19668）：相关（=10437）；无关（=9231）。生成了受者、死亡风险调整移植物存活和移植后十年内带功能移植物死亡的 Kaplan-Meier 曲线。多变量 Cox 比例风险模型用于检查供体-受者关系与感兴趣结局之间的关联。与相关组相比，IgA（10.1%比 6.5%，p<0.001）、FSGS（12.1%比 10%，-0.016）和狼疮肾炎（11.8%比 9.2%，-0.049）中，无关组在移植后 12 个月发生急性排斥反应的风险增加。在多变量模型中，生物学供体-受者关系与较差的受者或移植物存活或带功能移植物死亡无关。这些发现与活体相关供者肾移植的已知益处一致，反驳了供体-受者生物学关系对移植物结局可能产生不利影响的报告。
