Experience From an Active Preemptive Kidney Transplantation Program—809 Cases Revisited
Experience From an Active Preemptive Kidney Transplantation Program—809 Cases Revisited
复制标题
主动预防性肾移植项目的经验——809例回顾
作者：
B. Witczak;T. Leivestad;P. Line;H. Holdaas;A. Reisaeter;T. Jenssen;K. Midtvedt;J. Bitter;A. Hartmann
背景抢先肾移植（PKT）越来越被认可。我们想研究PKT高患病率的终末期肾病人群中积极PKT策略的结果。方法.从1989年到2007年，共进行了3400例首次肾移植，其中809例为PKT（24%）。PKT患者年轻7.4岁（P<0.001），有更多的活体供者（LD; 64% vs. 35%，P<0.001），较少的群体反应性人类白细胞抗原抗体阳性（2% vs. 6%，P<0.001）。结果在患者死亡率、未删失和死亡删失移植失败的考克斯回归分析中，除受体性别（即，受体和供体年龄、PKT、死亡供体[DD]、糖尿病肾病、人类白细胞抗原-DR错配和群体反应性抗体阳性）。对于患者死亡率，PKT和DD的风险比（HR）分别为0.75（P=0.001）和1.38（P<0.001）。未删失和死亡删失移植失败的结果相似。还分别对DD和LD队列进行了风险分析。结果相当，除了PKT不是LD队列中的显著风险因素（死亡率HR=0.82，P=0.12，未删失移植物失败HR=0.83，P=0.051）。然而，在DD受者中，PKT显著降低了患者死亡率（HR=0.70，P=0.004）和未删失移植失败率（HR=0.68，P<0.001）。结论PKT降低了DD受者的患者死亡率和未经审查的移植物失败风险。我们的研究证实了PKT在PKT患病率高的终末期肾病人群中的优势。
Background. Preemptive kidney transplantation (PKT) is increasingly acknowledged. We wanted to investigate the results of an active PKT policy in an unselected end-stage renal disease population with high prevalence of PKT. Methods. From 1989 to 2007, 3400 first kidney transplantations were performed in which 809 were PKTs (24%). PKT patients were 7.4 years younger (P<0.001), had more live donors (LD; 64% vs. 35%, P<0.001), and fewer were panel reactive human leukocyte antigen antibody positive (2% vs. 6%, P<0.001). Results. In the Cox regression analyses of patient mortality, uncensored and death-censored graft failures, all potential risk factors tested were statistically significant, except for recipient sex (i.e., recipient and donor age, PKT, deceased donor [DD], diabetes nephropathy, human leukocyte antigen-DR mismatch, and panel reactive antibody positivity). For patient mortality, PKT and DD had a hazard ratio (HR) of 0.75 (P=0.001) and 1.38 (P<0.001), respectively. The results were similar for uncensored and death-censored graft failures. Risk analyses were also performed separately for DD and LD cohorts. The results were comparable, except that PKT was not a significant risk factor in the LD cohort (HR=0.82, P=0.12 for mortality and HR=0.83, P=0.051 for uncensored graft failure). However, in DD recipients, patient mortality (HR=0.70, P=0.004) and uncensored graft failure (HR=0.68, P<0.001) were significantly reduced with PKT. Conclusion. PKT reduced the risk of patient mortality and uncensored graft failure in DD recipients. Our study confirms the advantages of PKT in an unselected end-stage renal disease population with a high prevalence of PKT.
进行先发性肾移植和非先发性肾移植的患者的比较。
DOI：
10.1016/j.ajkd.2003.07.007
发表时间：
2003
期刊：
American journal of kidney diseases : the official journal of the National Kidney Foundation
影响因子：
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作者：
Weng,FrancisL;Mange,KevinC
通讯作者：
Mange,KevinC