Moeinzadeh Firouzeh, Shahidi Shahrzad, Heidari Raheleh, Mortazavi Mojgan, Mansourian Marjan, Yadegar Bahareh Botlani
Isfahan Kidney Diseases Research Center, Al-Zahra Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran.
Isfahan Kidney Diseases Research Center, Khorshid Hospital, Isfahan University of Medical Sciences, Isfahan, Iran.
J Res Med Sci. 2025 Feb 28;30:11. doi: 10.4103/jrms.jrms_122_24. eCollection 2025.
There are conflicting results regarding survival in preemptive versus non-preemptive kidney transplant recipients. The present study aimed to estimate the risk of death in preemptive versus non-preemptive kidney transplant recipients.
In the present retrospective cohort study, all end-stage renal disease (ESRD) patients who underwent kidney transplantation between 1996 and 2021 in referral kidney transplantation centers in Isfahan province were investigated. In total, 499 patients who received dialysis before kidney transplantation (non-preemptive) and 168 patients who received no dialysis before kidney transplantation (preemptive) were included in the final analysis. Data regarding demographic and clinical variables including sex, age, body mass index (BMI), follow-up duration, immunosuppressive regimen change, kidney donor type, underlying causes of ESRD, and comorbidities before and after kidney transplantation were collected.
The mean age was 55.47 ± 15.53 years in preemptive and 54.87 ± 14.69 years in non-preemptive patients ( = 0.65). Mortality rates were 24.44/1000 person-years of follow-up for preemptive and 18.25/1000 person-years of follow-up for non-preemptive patients ( = 0.013). In the crude model of Cox regression analysis, preemptive kidney transplant recipients had a significantly higher risk of mortality compared to non-preemptive kidney transplant recipients (hazard ratio [HR] = 1.59; 95% confidence interval [CI]: 1.09-2.33; = 0.015). However, the association attenuated and became insignificant after adjustment for confounders, including age, BMI, immunosuppressive regimen change, kidney donor type, and comorbidities (HR = 1.35; 95% CI: 0.92-1.99; = 0.12).
The results of the present study indicated that there is no independent association between preemptive kidney transplantation and increased risk of mortality.
关于抢先式与非抢先式肾移植受者的生存情况，研究结果存在冲突。本研究旨在评估抢先式与非抢先式肾移植受者的死亡风险。
在本回顾性队列研究中，对1996年至2021年期间在伊斯法罕省转诊肾移植中心接受肾移植的所有终末期肾病（ESRD）患者进行了调查。最终分析纳入了499例肾移植前接受透析的患者（非抢先式）和168例肾移植前未接受透析的患者（抢先式）。收集了包括性别、年龄、体重指数（BMI）、随访时间、免疫抑制方案改变、肾供体类型、ESRD的潜在病因以及肾移植前后合并症等人口统计学和临床变量的数据。
抢先式患者的平均年龄为55.47±15.53岁，非抢先式患者为54.87±14.69岁（P = 0.65）。抢先式患者的死亡率为每1000人年随访24.44例，非抢先式患者为每1000人年随访18.25例（P = 0.013）。在Cox回归分析的粗模型中，抢先式肾移植受者的死亡风险显著高于非抢先式肾移植受者（风险比[HR]=1.59；95%置信区间[CI]：1.09 - 2.33；P = 0.015）。然而，在对包括年龄、BMI、免疫抑制方案改变、肾供体类型和合并症在内的混杂因素进行调整后，这种关联减弱且变得不显著（HR = 1.35；95%CI：0.92 - 1.99；P = 0.12）。
本研究结果表明，抢先式肾移植与死亡风险增加之间不存在独立关联。
