Survival With Dialysis Versus Kidney Transplantation in Adult Hemolytic Uremic Syndrome Patients: A Fifteen-Year Study of the Waiting List
Survival With Dialysis Versus Kidney Transplantation in Adult Hemolytic Uremic Syndrome Patients: A Fifteen-Year Study of the Waiting List
复制标题
成人溶血性尿毒症综合征患者透析与肾移植的生存率：针对等候名单的十五年研究
DOI：
10.1097/tp.0000000000000784
复制
发表时间：
2015
期刊：
影响因子：
6.2
通讯作者：
K. Andreoni
中科院分区：
文献类型：
--
作者：
Alfonso H. Santos;M. Casey;X. Wen;I. Zendejas;S. Rehman;K. Womer;K. Andreoni
背景：缺乏罕见终末期肾病（ESRD）病因的肾移植受者的生存数据。目前还没有大型的登记研究比较透析与肾移植的生存结果的等待名单的成人溶血性尿毒综合征（HUS）。材料和方法我们回顾性研究了1996年至2011年美国肾移植等待名单上的成人HUS终末期肾病患者（n = 559）。我们分别使用Kaplan-Meier和考克斯风险模型分析了5年移植和患者生存概率和风险因素。采用相似模型，分析糖尿病（DM）、高血压（HTN）和肾小球肾炎（GN）患者的等待名单和移植结局，然后与HUS患者进行比较。结果与等待透析的成人HUS患者相比，活体供肾移植受者（风险比[HR]，0.27，95%置信区间[95% CI]，0.11-0.65）和标准死亡供肾移植受者（HR，0.52; 95% CI，0.29-0.94）的5年死亡风险分别降低73%和48%。在HUS中，总体移植受者队列的5年死亡率风险分别比透析维持队列低44%、50%、54%和55（HR，0.56; 95%CI，0.35-0.91）、HTN（HR，0.50; 95%CI，0.48-0.52）、GN（HR，0.46; 95%CI，0.44-0.49）和DM（HR，0.45; 95%CI，0.44-0.47）组。等待HUS队列的5年移植概率为60%，而DM和HTN队列为42%至49%（P < 0.001），GN队列为62%（P = 0.93）。结论：在等待名单上的HUS成人患者中，活体和标准死亡供体肾移植比透析提供了显著的生存益处。在等待名单中，HUS的5年移植概率高于DM和HTN患者。
Background Survival data are lacking for kidney transplant recipients with rare native end-stage renal disease (ESRD) etiologies. There is currently no large registry study comparing dialysis versus kidney transplantation survival outcomes of waitlisted adults with hemolytic uremic syndrome (HUS). Materials and Methods We retrospectively studied adult-HUS end-stage renal disease patients (n = 559) placed on the US kidney transplant waitlist in 1996 to 2011. We analyzed 5-year transplantation and patient survival probabilities and risk factors using Kaplan-Meier and Cox hazards models, respectively. Using similar models, waitlist and transplantation outcomes of patients with diabetes mellitus (DM), hypertension (HTN), and glomerulonephritis (GN) were analyzed, and then compared with HUS patients. Results Compared with waitlisted adult HUS patients on dialysis, 5-year mortality risks were 73% and 48% lower in recipients of living (hazard ratio [HR], 0.27, 95% confidence interval [95% CI], 0.11-0.65) and standard deceased (HR, 0.52; 95% CI, 0.29-0.94) donor kidney transplants, respectively. Mortality risks over 5 years were 44%, 50%, 54%, and 55% lower in the overall transplant recipient cohorts than in the dialysis-maintained cohorts within the HUS (HR, 0.56; 95% CI, 0.35-0.91), HTN (HR, 0.50; 95% CI, 0.48-0.52), GN (HR, 0.46; 95% CI, 0.44-0.49), and DM (HR, 0.45; 95% CI, 0.44-0.47) groups, respectively. Five-year transplantation probability in the waitlisted HUS cohort was 60% versus 42% to 49% (P < 0.001) in the DM and HTN cohorts, and 62% (P = 0.93) in the GN cohort. Conclusions Living and standard criteria deceased donor kidney transplants provide significant survival benefit over dialysis in waitlisted adults with HUS. On the waitlist, the 5-year transplantation probability was higher in HUS than in DM and HTN patients.
肾移植受者溶血性尿毒症综合征的复发。
DOI：
--
发表时间：
1986
期刊：
Kidney international. Supplement
影响因子：
--
作者：
Hebert,D;Sibley,RK;Mauer,SM
通讯作者：
Mauer,SM