Universidade de Ciências da Saúde de Porto Alegre, Porto Alegre, RS, Brazil.
Santa Casa de Misericórdia de Porto Alegre, Porto Alegre, RS, Brazil.
J Bras Nefrol. 2024 Jan-Mar;46(1):79-84. doi: 10.1590/2175-8239-JBN-2022-0132en.
The aim of this study was to analyze the waiting list for kidney transplantation in our hospital according to candidate's panel reactive antibodies (cPRA) and its outcomes.
One thousand six hundred forty patients who were on the waiting list between 2015 and 2019 were included. For the analysis, hazard ratios (HR) for transplant were estimated by Fine and Gray's regression model according to panel reactivity and HR for graft loss and death after transplantation.
The mean age was 45.39 ± 18.22 years. Male gender was predominant (61.2%), but the proportion decreased linearly with the increase in cPRA (p < 0.001). The distribution of patients according to panels were: 0% (n = 390), 1% - 49% (n = 517), 50% - 84% (n = 269), and ≥ 85% (n = 226). Transplantation was achieved in 85.5% of the sample within a median time of 8 months (CI 95%: 6.9 - 9.1). The estimated HRs for transplantation during the follow-up were 2.84 (95% CI: 2.51 - 3.34), 2.41(95%CI: 2.07 - 2.80), and 2.45(95%CI: 2.08 - 2.90) in the cPRA range of 0%, 1%-49%, and 50%-84%, respectively, compared to cPRA ≥ 85 (p < 0.001). After transplantation, the HR for graft loss was similar in the different cPRA groups, but the HR for death (0.46 95% CI 0.24-0.89 p = 0.022) was lower in the 0% cPRA group when adjusted for age, gender, and presence of donor specific antibodies (DSA).
Patients with cPRA below 85% are more than twice as likely to receive a kidney transplantation with a shorter waiting time. The risk of graft loss after transplantation was similar in the different cPRA groups, and the adjusted risk of death was lower in nonsensitized recipients.
本研究旨在根据候选者的 panel reactive antibodies (cPRA) 及其结果分析我院的肾移植候补者名单。
纳入了 2015 年至 2019 年期间在候补名单上的 1640 名患者。为了分析，根据面板反应性，通过 Fine 和 Gray 的回归模型估计了移植的风险比 (HR)，并估计了移植后移植物丢失和死亡的 HR。
平均年龄为 45.39 ± 18.22 岁。男性为主（61.2%），但随着 cPRA 的增加，比例呈线性下降（p < 0.001）。根据面板对患者的分布情况如下：0%（n = 390）、1% - 49%（n = 517）、50% - 84%（n = 269）和≥ 85%（n = 226）。在中位时间为 8 个月（95%CI：6.9-9.1）内，85.5%的样本进行了移植。在随访期间，cPRA 为 0%、1%-49%和 50%-84%时，与 cPRA≥85%相比，移植的估计 HR 分别为 2.84（95%CI：2.51-3.34）、2.41（95%CI：2.07-2.80）和 2.45（95%CI：2.08-2.90）（p < 0.001）。移植后，不同 cPRA 组之间移植物丢失的 HR 相似，但在调整年龄、性别和供体特异性抗体 (DSA) 后，0% cPRA 组的死亡 HR（0.46 95%CI 0.24-0.89 p = 0.022）较低。
cPRA 低于 85%的患者接受肾移植的可能性是 cPRA 高于 85%的患者的两倍多，等待时间更短。不同 cPRA 组之间移植后移植物丢失的风险相似，未致敏受者的调整后死亡风险较低。
