Sesso R, Josephson M A, Anção M S, Draibe S A, Sigulem D
Department of Medicine, Escola Paulista de Medicina, Universidade Federal de São Paulo, Brazil.
J Am Soc Nephrol. 1998 Apr;9(4):684-91. doi: 10.1681/ASN.V94684.
Due to the shortage of cadaveric organs, kidneys from living unrelated donors (LUD) are increasingly being used for transplantation. The long-term outcome for LUD recipients is not completely known. This study was undertaken to evaluate the long-term graft survival in LUD recipients and compare it with that of cadaver donor allograft recipients. Three hundred and sixty-four LUD and 3881 cadaveric kidney recipients were evaluated using data obtained through the Brazilian Renal Transplant Registry. Transplants performed between January 1, 1987, and June 30, 1996, were eligible for analysis. Graft and patient survival were estimated by the Kaplan-Meier method. Sixty percent of the LUD were from spouses. The median duration of follow-up was 23.8 mo (0 to 117.2 mo). Patient survival rates were not significantly different for LUD and cadaveric kidney recipients (69% [95% confidence interval (CI), 61.9 to 76.1%] versus 73.2% [71 to 75.4%] at 5 yr; 69% [61.9 to 76.1%] versus 60.6% [55.1 to 66.1%] at 9.6 yr). Graft survival rates for recipients of LUD allografts were similar to those for cadaveric kidneys at 5 yr (50.1% [43.2 to 57%] versus 50.4% [48.1 to 52.8%]) and higher, although not significantly, at 9.6 yr (45.7% [37.7 to 53.7%] versus 32.7% [26.4 to 39%], respectively, P = 0.14). In a multivariate analysis using the Cox proportional hazards regression model, after adjusting for recipient age, race, history of previous transplantation, and year of transplantation, the risk of graft failure was 16% (95% CI, -3% to 31%) lower for LUD than cadaveric recipients. We conclude that LUD are an excellent alternative to cadaveric kidney donors. The long-term patient and graft survival rates for recipients of LUD allografts are at least as good as those for recipients of cadaveric kidneys.
由于尸体器官短缺，来自非亲属活体供者（LUD）的肾脏越来越多地被用于移植。LUD受者的长期预后尚不完全清楚。本研究旨在评估LUD受者的长期移植物存活情况，并与尸体供肾移植受者进行比较。利用巴西肾脏移植登记处获得的数据，对364例LUD和3881例尸体肾受者进行了评估。1987年1月1日至1996年6月30日期间进行的移植符合分析条件。采用Kaplan-Meier法估计移植物和患者生存率。60%的LUD供者为配偶。随访时间中位数为23.8个月（0至117.2个月）。LUD和尸体肾受者的患者生存率无显著差异（5年时分别为69%[95%置信区间（CI），61.9%至76.1%]和73.2%[71%至75.4%]；9.6年时分别为69%[61.9%至76.1%]和60.6%[55.1%至66.1%]）。LUD同种异体移植受者的移植物生存率在5年时与尸体肾相似（分别为50.1%[43.2%至57%]和50.4%[48.1%至52.8%]），在9.6年时虽无显著差异但更高（分别为45.7%[37.7%至53.7%]和32.7%[26.4%至39%]，P = 0.14）。在使用Cox比例风险回归模型进行的多变量分析中，在调整受者年龄、种族、既往移植史和移植年份后，LUD受者移植物失败的风险比尸体肾受者低16%（95%CI，-3%至31%）。我们得出结论，LUD是尸体肾供者的极佳替代选择。LUD同种异体移植受者的长期患者和移植物生存率至少与尸体肾受者一样好。
