Inferior allograft outcomes in adolescent recipients of renal transplants from ideal deceased donors.
Inferior allograft outcomes in adolescent recipients of renal transplants from ideal deceased donors.
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DOI：
10.1097/sla.0b013e3182471665
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发表时间：
2012-03
影响因子：
9
通讯作者：
Abt PL
中科院分区：
文献类型：
--
作者：
Levine MH;Reese PP;Wood A;Baluarte JH;Huverserian A;Naji A;Abt PL
衡量Share-35政策对理想已故供肾分配的影响，并检查年龄对理想供肾肾移植后结果的影响。在美国，通过Share-35, 18岁以下的移植候选人优先获得最高质量的已故供体肾脏。然而，青少年（15 - 18岁）肾移植受者（KTRs）由于急性排斥反应率升高和原发性肾脏疾病复发的风险增加，可能更容易发生同种异体移植物丢失。我们使用注册表数据对1994年1月1日至2008年12月31日期间39,136例ktr患者进行回顾性队列研究。理想供体定义为2 - 34岁，肌酐<1.5mg/dL，无高血压、糖尿病和丙型肝炎。Share-35后，分配给儿童受体的理想供体肾脏比例从7%增加到16%。在多变量Cox回归中，与青少年KTRs相比，除bb0 ~ 70岁的受体外，所有年龄层的移植失败风险均较低（p<0.01）；在排除复发高风险疾病的KTRs后，结果相似。青少年受助人的死亡率高于14岁以下受助人，与18岁和40岁以下受助人的死亡率相似，低于40岁以上受助人的死亡率。将“理想捐赠者”分配给青少年接受者可能无法使移植效用最大化。重新评估儿童分配优先级可能为优化理想的同种异体肾移植生存提供机会。
To measure the impact of the Share-35 policy on the allocation of ideal deceased donor kidneys, and to examine the impact of age on outcomes after kidney transplantation using ideal donor kidneys. In the United States, through Share-35, transplant candidates <18 years of age receive priority for the highest-quality deceased donor kidneys. Adolescent (15 – 18 years) kidney transplant recipients (KTRs), however, may be more susceptible to allograft loss due to elevated rates of acute rejection and a possible increased risk of primary renal disease recurrence. We used registry data to perform a retrospective cohort study of 39,136 KTRs from 1/1/1994 – 12/31/2008. Ideal donors were defined as 2 – 34 years old with creatinine <1.5mg/dL and absence of hypertension, diabetes and hepatitis C. After Share-35, the percentage of ideal donor kidneys allocated to pediatric recipients increased from 7 – 16%. In multivariable Cox regression, compared to adolescent KTRs, all age strata except recipients >70 years had a lower risk of allograft failure (p<0.01 for each comparison); results were similar after excluding KTRs with diseases at high risk of recurrence. Adolescent recipients had higher mortality rates than KTRs under 14 years, similar mortality compared to KTRs >18 and <40 years, and lower mortality than KTRs over 40 years. The allocation of “ideal donors” to adolescent recipients may not maximize graft utility. Re-evaluation of pediatric allocation priority may offer opportunities to optimize ideal renal allograft survival.