Schnuelle P, Lorenz D, Trede M, Van Der Woude F J
Fifth Medical Clinic, University Hospital Mannheim, Medical Faculty of the University of Heidelberg, Germany.
J Am Soc Nephrol. 1998 Nov;9(11):2135-41. doi: 10.1681/ASN.V9112135.
Despite a superior quality of life and a favorable cost effectiveness, it has not been well established thus far whether renal cadaveric transplantation contributes to superior survival probability of end-stage renal disease patients in Europe, because the mortality rate on dialysis is lower compared with the United States. This analysis was undertaken to compare the mortality of wait-listed patients and transplant recipients during long-term follow-up, including the possibility of a retransplant in a single-center study. The study cohort included 309 consecutive patients, ages 17 to 72 yr, being registered on the waiting list of the Renal Transplantation Center of Mannheim since the initiation of the transplantation program on June 3, 1989. Follow-up was terminated on September 30, 1997, with a mean of 4.15 yr. A total of 144 renal cadaveric transplants (four retransplants) was performed during the follow-up period. A Cox regression model considering the time-dependent exposure to the different therapy modalities was applied for statistical analysis. Patients being removed from the waiting list or coming back to dialysis after transplantation were censored at time of withdrawal or graft failure. Transplantation resulted in a lower hazard ratio, which was 0.36 (95% confidence interval, 0.15 to 0.87) when the hazard of the wait-listed group was taken as 1.00. The underlying incidence rate of death was 0.026 per patient-year (0.032 on dialysis versus 0.016 with functioning graft). Performing the evaluation on an intention-to-treat basis without censoring the lower risk of the transplanted group was still pronounced according to a hazard ratio of 0.44 (95% confidence interval, 0.22 to 0.89). Thus, patients receiving a renal cadaveric transplantation have a substantial survival advantage over corresponding end-stage renal disease patients on the waiting list even in the setting of a single transplantation center where mortality on regular dialysis therapy was comparatively low.
尽管尸体肾移植具有较高的生活质量和良好的成本效益，但迄今为止，在欧洲尸体肾移植是否能提高终末期肾病患者的生存率尚未明确，因为与美国相比，透析患者的死亡率较低。本分析旨在比较长期随访期间等待移植患者和移植受者的死亡率，包括在单中心研究中再次移植的可能性。研究队列包括自1989年6月3日移植项目启动以来在曼海姆肾移植中心等待名单上登记的309例连续患者，年龄在17至72岁之间。随访于1997年9月30日结束，平均随访时间为4.15年。随访期间共进行了144例尸体肾移植（4例再次移植）。采用考虑不同治疗方式时间依赖性暴露的Cox回归模型进行统计分析。从等待名单上移除或移植后重新开始透析的患者在退出或移植物失败时被截尾。移植导致较低的风险比，以等待移植组的风险为1.00时，风险比为0.36（95%置信区间，0.15至0.87）。潜在的死亡发生率为每患者年0.026（透析患者为0.032，有功能移植物患者为0.016）。在意向性治疗基础上进行评估，不对移植组较低的风险进行截尾，风险比仍为0.44（95%置信区间，0.22至0.89），差异仍然显著。因此，即使在常规透析治疗死亡率相对较低的单移植中心背景下，接受尸体肾移植的患者比等待名单上相应的终末期肾病患者具有显著的生存优势。
