Late Graft Loss After Kidney Transplantation: Is "Death With Function" Really Death With a Functioning Allograft?
Late Graft Loss After Kidney Transplantation: Is "Death With Function" Really Death With a Functioning Allograft?
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DOI：
10.1097/tp.0000000000002961
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发表时间：
2020-07-01
期刊：
影响因子：
6.2
通讯作者：
Matas, Arthur J.
中科院分区：
文献类型：
--
作者：
Gaston, Robert S.;Fieberg, Ann;Matas, Arthur J.
背景大约一半的晚期肾移植失败归因于功能性死亡（死亡），这是一种特征不明确的结局。一个持续的问题是，移植物功能障碍是否是慢性移植物功能障碍的结果。使用前瞻性长期移植肾功能恶化研究数据库，我们试图更好地定义当今时代肾功能恶化的影响、表型和临床过程。方法.对3587例移植后90天移植肾功能正常的肾移植受者进行了中位5.2年的前瞻性随访。结果在移植的特点，在那些与（N = 350，9.8%）与移植物丢失的患者不同（死亡删失移植物衰竭[DC-GF]，N = 295，8.2%）或维持功能（N = 2942，82.0%）; DC-GF患者年龄大，病情重，透析时间长，有更多的心血管疾病，而DC-GF患者经历了更多的早期排斥反应，90天后出现更多急性排斥反应，移植物衰竭前肾功能出现临床显著下降。与此相反，在移植后的临床过程中，在死亡之前，在肾功能恢复的患者与那些在整个过程中保持功能的患者没有什么不同。结论.肾移植受者中的CD 4+和DC-GF代表不同患者群体中发生的不同临床表型。减少工作量不足的影响需要更好地定义原因和临床过程，然后进行治疗试验以改善结果。在临床试验中，将顺铂和DC-GF组合在一起的复合终点可能会掩盖重要的临床发现。
Background. About half of late kidney allograft losses are attributed to death with function (DWF), a poorly characterized outcome. An ongoing question is whether DWF is a consequence of chronic allograft dysfunction. Using the prospective Long-term Deterioration of Kidney Allograft Function study database, we sought to better define the impact, phenotype, and clinical course of DWF in the current era. Methods. Three thousand five hundred eighty-seven kidney recipients with functional grafts at 90 days post-transplant were followed prospectively for a median of 5.2 years. Results. Characteristics at transplantation in those with DWF (N = 350, 9.8%) differed from those who otherwise lost their grafts (death-censored graft failure [DC-GF], N = 295, 8.2%) or maintained function (N = 2942, 82.0%); DWF patients were older, sicker, and had been on dialysis longer, with more preexisting cardiovascular disease, whereas DC-GF patients experienced more early rejection, more acute rejection after 90 days, and a clinically significant decrease in kidney function before graft failure. In contrast, the clinical course after transplantation in DWF patients did not differ before death from those who maintained function throughout. Conclusions. DWF and DC-GF in kidney transplant recipients represent differing clinical phenotypes occurring in distinct patient populations. Reducing the impact of DWF requires better definition of causes and clinical course and then trials of therapies to improve outcomes. Composite endpoints in clinical trials that group DWF and DC-GF together may obscure important clinical findings.