Survival Benefit in Older Patients Associated With Earlier Transplant With High KDPI Kidneys
Survival Benefit in Older Patients Associated With Earlier Transplant With High KDPI Kidneys
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DOI：
10.1097/tp.0000000000001405
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发表时间：
2017-04-01
期刊：
影响因子：
6.2
通讯作者：
Stegall, Mark D.
中科院分区：
文献类型：
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作者：
Jay, Colleen L.;Washburn, Kenneth;Stegall, Mark D.
背景考虑到60岁以上患者的透析死亡率较高，接受肾脏供体特征指数（KDPI）评分较高的肾脏可能有助于早期和潜在的抢先移植（preKT）。然而，关于老年患者高KDPI同种异体移植物风险的证据有限。我们的目的是确定KDPI大于85%的老年患者与等待名单上的患者相比，优先或不优先移植的相对益处。方法.分析了2003年至2012年美国器官共享网络（United Network of Organ Sharing）关于成人已故供体肾移植候选人的数据，以根据多变量考克斯回归模型，评价60岁以上患者中接受预KT和非预KT KDPI大于85%移植的患者与等待名单上的候选人（包括接受KDPI 0%至85%移植的患者）相比的生存率。结果在移植后第一年，KDPI大于85%的60岁以上受者的移植，preKT具有降低的死亡风险（风险比[HR]，0.61; 95%置信区间[95% CI]，0.41-0.90）和非术前KT增加死亡风险（HR，1.15; 95% CI，1.03-1.27）与包括KDPI 0%至85%移植受者的等待名单相比。在1 - 2年和2年后，两个KDPI大于85%的组的死亡率显著降低（1-2年：KT前HR，0.38; 95% CI，[0.23-0.60]和非KT前HR，0.52; 95% CI，0.45-0.61; 2+年：KT前HR，0.50; 95% CI，0.38-0.66和非KT前HR，0.64; 95% CI，0.58-0.70）。结论.在60岁以上的患者中，与包括KDPI 0%至85%移植的等待名单相比，PreKT和非preKT KDPI大于85%移植与第一年后较低的死亡率风险相关。应进一步考虑在老年患者中增加高KDPI移植物的使用，以避免或限制透析时间。
Background. Given high dialysis mortality rates for patients older than 60 years, accepting a kidney with a high Kidney Donor Profile Index (KDPI) score could enable earlier and potentially preemptive transplantation (preKT). However, evidence regarding the risks of high KDPI allografts in older patients is limited. Our objective was to determine the relative benefit for older patients of KDPI greater than 85% transplant either preemptively or not compared with remaining on the waitlist. Methods. United Network of Organ Sharing data from 2003 to 2012 for adult deceased donor kidney transplant candidates was analyzed to evaluate patient survival in patients older than 60 years for preKT and non-preKT KDPI greater than 85% transplants compared with candidates remaining on the waitlist including patients who received KDPI 0% to 85% transplants according to multivariate Cox regression models. Results. In the first year posttransplant for KDPI greater than 85% of transplants in recipients older than 60 years, preKT had a reduced mortality hazard (hazards ratio [HR], 0.61; 95% confidence interval [95% CI], 0.41-0.90) and non-preKT an increased mortality hazard (HR, 1.15; 95% CI, 1.03-1.27) compared with the waitlist including KDPI 0% to 85% transplant recipients. At 1 to 2 years and after 2 years, both KDPI greater than 85% groups had significant reductions in mortality (1-2 years: preKT HR, 0.38; 95% CI, [0.23-0.60] and non-preKT HR, 0.52; 95% CI, 0.45-0.61; and 2+ years: preKT HR, 0.50; 95% CI, 0.38-0.66 and non-preKT HR, 0.64; 95% CI, 0.58-0.70, respectively). Conclusions. PreKT and non-preKT KDPI greater than 85% transplant was associated with lower mortality hazard after the first year compared with the waitlist including KDPI 0% to 85% transplants in patients older than 60 years. Further consideration should be given to increased utilization of high KDPI grafts in older patients with the goal of avoiding or limiting time on dialysis.