Division of Nephrology and Kidney Center, Kobe University Graduate School of Medicine, 7-5-2 Kusunoki-Cho, Chuo-Ku, Kobe, 650-0017, Japan.
Committee of the Renal Data Registry, Japanese Society for Dialysis Therapy, Tokyo, Japan.
Clin Exp Nephrol. 2024 Feb;28(2):165-174. doi: 10.1007/s10157-023-02417-y. Epub 2023 Oct 21.
Donors bravely donate their kidneys because they expect that living donor kidney transplantation (LKT) confers benefits to recipients. However, the magnitude of the survival benefit of LKT is uncertain.
This prospective cohort study used two Japanese nationwide databases for dialysis and kidney transplantation and included 862 LKT recipients and 285,242 hemodialysis (HD) patients in the main model and 5299 LKT recipients and 151,074 HD patients in the supplementary model. We employed time-dependent model in the main model and assessed the hazard ratio and the difference in the restricted mean survival time (RMST) between LKT recipients and HD patients. In the main analysis of the main model (LKT, N = 675; HD, N = 675), we matched LKT recipients with HD patients by age, sex, dialysis vintage, and cause of renal failure and excluded HD patients with dementia or performance status grades 2, 3, or 4.
The median observational period was 8.00 (IQR 3.58-8.00) years. LKT was significantly associated with a lower risk of mortality (hazard ratios (95% confidence interval (CI)), 0.50 (0.35-0.72)) and an increase in life expectancy (7-year RMST differences (95% CI), 0.48 (0.35-0.60) years) compared with HD. In subgroup analysis, the survival benefit of LKT was greater in female patients than in male patients in the Cox model; whereas older patients gained longer life expectancy compared with younger patients.
LKT was associated with better survival benefits than HD, and the estimated increase in life expectancy was 0.48 years for 7 years.
捐献者勇敢地捐献肾脏，因为他们期望活体供肾移植（LKT）能使受者受益。然而，LKT 的生存获益幅度尚不确定。
本前瞻性队列研究使用了日本两个透析和肾移植的全国性数据库，纳入了 675 例 LKT 受者和 675 例血液透析（HD）患者的主模型以及 5299 例 LKT 受者和 151074 例 HD 患者的补充模型。我们在主模型中采用时间依赖性模型，评估了 LKT 受者与 HD 患者之间的风险比和限制平均生存时间（RMST）差异。在主模型的主要分析中（LKT，N=675；HD，N=675），我们按年龄、性别、透析龄和肾衰竭病因对 LKT 受者和 HD 患者进行了匹配，并排除了痴呆或体能状态等级为 2、3 或 4 的 HD 患者。
中位观察期为 8.00（IQR 3.58-8.00）年。与 HD 相比，LKT 显著降低了死亡风险（风险比（95%置信区间（CI）），0.50（0.35-0.72））和增加了预期寿命（7 年 RMST 差异（95% CI），0.48（0.35-0.60）年）。在亚组分析中，在 Cox 模型中，LKT 对女性患者的生存获益大于男性患者；而与年轻患者相比，老年患者获得了更长的预期寿命。
与 HD 相比，LKT 与更好的生存获益相关，7 年内预期寿命增加了 0.48 年。
