Survival Benefit in Renal Transplantation Despite High Comorbidity
Survival Benefit in Renal Transplantation Despite High Comorbidity
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DOI：
10.1097/tp.0000000000001002
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发表时间：
2016-10-01
期刊：
影响因子：
6.2
通讯作者：
Sorensen, Soren Schwartz
中科院分区：
文献类型：
--
作者：
Sorensen, Vibeke Romming;Heaf, James;Sorensen, Soren Schwartz
背景：移植受者的年龄和合并症程度正在增加。考虑到可用于移植的器官的稀缺性，了解与受者年龄和合并症有关的生存益处是重要的。本研究的目的是分析不同年龄段和不同程度共病评分的患者在进入等待名单时移植的机会和生存效益。方法合并丹麦肾脏病登记和SCANCAATRINT的数据。Charlson共病指数得分来自丹麦国家招生登记处。学习时间为1995年1月1日至2011年12月31日。采用多状态模型分析不同患者组的肾移植机会和移植效果。结果65岁以上患者和合并症评分高的患者肾移植机会较低。然而，如果65岁以上的患者移植的是已故供者，死亡风险降低了55%(风险率，0.45(0.26-0.75))。在共病评分为5或更高的患者中，接受已故供者移植可将死亡风险降低72%(危险率，0.28(0.20-0.39))。移植患者的总体生存收益为62%，而活体移植患者为70%。结论健康状况差和高龄降低了移植的机会。然而，65岁以上的患者和合并症较高的患者仍然可以从肾移植中获得生存益处。
Background The age and degree of comorbidity among transplant candidates is increasing. Knowledge of survival benefit in relation to recipient age and comorbidity is important, considering the scarcity of organs available for transplantation. The aim of the present study was to analyze the chances and survival benefit of transplantation among patients in different age groups and with different degrees of comorbidity score at the time of entering the waiting list.Methods Data from the Danish Nephrology Registry and Scandiatransplant were merged. Charlson Comorbidity Index scores were derived from the National Danish Admissions Registry. Study period is from January 1, 1995, to December 31, 2011. A multistate model was used to analyze the chance of having a renal transplantation and the effect of transplantation in different patients groups.Results Patients older than 65 years and patients with high comorbidity score had a decreased chance of being transplanted. However, if patients older than 65 years were transplanted with deceased donor, the mortality risk was reduced by 55% (hazard rate, 0.45 (0.26-0.75). In patients with a comorbidity score of 5 or greater, receiving a deceased donor transplant reduced the mortality risk by 72% (hazard rate, 0.28 (0.20-0.39). The overall survival benefit was 62% versus 70% in deceased versus living donor transplanted patients.Conclusions Poor health and old age reduced the chance of being transplanted. However, patients older than 65 years and patients with high comorbidity still had a survival benefit from renal transplantation.