Long-Term Renal Allograft Survival in the United States: A Critical Reappraisal
Long-Term Renal Allograft Survival in the United States: A Critical Reappraisal
复制标题
DOI：
10.1111/j.1600-6143.2010.03283.x
复制
发表时间：
2011-03-01
影响因子：
8.8
通讯作者：
Meier-Kriesche, H. -U
中科院分区：
文献类型：
--
作者：
Lamb, K. E.;Lodhi, S.;Meier-Kriesche, H. -U
在过去的几十年里，肾移植存活率大大提高;这主要归因于第一年存活率的提高。本报告描述了美国肾移植存活率的演变，在1989年至2009年期间，共有252910例患者接受了单器官肾移植。根据Kaplan-Meier和考克斯模型获得半衰期。1989年死亡供体移植的移植物半衰期为6.6年，1995年增加到8年，2000年后进一步增加到2005年的8.8年。更显着的改善是在更高风险的移植，如ECD接受者的半衰期从1989年的3年增加到2005年的6.4年。在低风险人群中，如活体供者-受者，半衰期没有变化，1989年为11.4年，2005年为11.9年。第一年的自然减员率在所有分组中显示出巨大的改善;然而，第一年之后的自然减员率仅显示出微小的改善，并且在黑人接受者中更为明显。在过去的二十年里，肾移植取得了重大进展，主要是由于短期移植物存活率的提高，但长期磨损正在缓慢改善，并可能在未来取得更大的进展。
Renal allograft survival has increased tremendously over past decades; this has been mostly attributed to improvements in first-year survival. This report describes the evolution of renal allograft survival in the United States where a total of 252 910 patients received a single-organ kidney transplant between 1989 and 2009. Half-lives were obtained from the Kaplan-Meier and Cox models. Graft half-life for deceased-donor transplants was 6.6 years in 1989, increased to 8 years in 1995, then after the year 2000 further increased to 8.8 years by 2005. More significant improvements were made in higher risk transplants like ECD recipients where the half-lives increased from 3 years in 1989 to 6.4 years in 2005. In low-risk populations like living-donor-recipients half-life did not change with 11.4 years in 1989 and 11.9 years in 2005. First-year attrition rates show dramatic improvements across all subgroups; however, attrition rates beyond the first year show only small improvements and are somewhat more evident in black recipients. The significant progress that has occurred over the last two decades in renal transplantation is mostly driven by improvements in short-term graft survival but long-term attrition is slowly improving and could lead to bigger advances in the future.