Effect of the use or nonuse of long-term dialysis on the subsequent survival of renal transplants from living donors.
Effect of the use or nonuse of long-term dialysis on the subsequent survival of renal transplants from living donors.
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DOI：
10.1056/nejm200103083441004
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发表时间：
2001-03-08
影响因子：
158.5
通讯作者：
Feldman, HI
中科院分区：
文献类型：
--
作者：
Mange, KC;Joffe, MM;Feldman, HI
背景资料：从活体捐赠者的肾移植的移植存活的影响，而不是以前开始的长期dialysis.Methods：使用数据从美国肾脏数据系统，我们进行了一项回顾性队列研究8481例患者谁是或谁没有接受长期透析之前，从活体捐赠者的肾移植。通过比例风险分析，对移植前未接受过长期透析的患者与接受过长期透析的患者进行比较，评估移植失败的相对发生率，并调整潜在的混杂变量，包括移植中心和家庭收入中位数。接受未经透析的活体供肾者的肾移植通过条件Logistic回归分析评估移植后6个月内活检证实的急性排斥反应的风险，并对移植中心进行调整。移植来自活体供者的肾脏而没有长期透析史的患者在移植后的第一年内移植失败的风险降低了52%与透析后移植相比，第二年减少82%（率比，0.18; P= 0.001），随后几年减少86%（率比，0.14; P=0.001）。当对第一年内发生急性排斥反应的时间进行调整时，第一年内同种异体移植物失败率的降低幅度减弱（率比，0.69; 95%置信区间，0.44至1.10; P=0.10）。透析持续时间的增加与移植后6个月内排斥反应的几率增加有关（P=0.001）。结论：在没有先前开始透析的情况下，活体供肾的抢先移植与透析开始后进行的移植相比，移植物存活时间更长。（N Engl J Med 2001;344：726-31.）版权所有（C）2001马萨诸塞州医学会。
Background: The effect on allograft survival of the transplantation of kidneys from living donors without the previous initiation of long-term dialysis is controversial.Methods: Using data from the U.S. Renal Data System, we performed a retrospective cohort study of 8481 patients who were or who were not treated by long-term dialysis before receiving a kidney transplant from a living donor. The relative rate of allograft failure for patients who received a transplant without previously undergoing long-term dialysis, as compared with patients who underwent long-term dialysis before transplantation, was assessed by proportional-hazards analysis, with adjustment for potential confounding variables, including the transplantation center and median household income. The association between the receipt of a kidney transplant from a living donor without previous dialysis ("preemptive'' transplantation) and the risk of biopsy-confirmed acute rejection within six months after transplantation was evaluated by conditional logistic-regression analysis, with adjustment for the transplantation center.Results: Transplantation of a kidney from a living donor without previous long-term dialysis was associated with a 52 percent reduction in the risk of allograft failure during the first year after transplantation (rate ratio, 0.48; P=0.002), an 82 percent reduction during the second year (rate ratio, 0.18; P=0.001), and an 86 percent reduction during subsequent years (rate ratio, 0.14; P=0.001), as compared with transplantation after dialysis. The reduction in the rate of allograft failure during the first year was attenuated when adjustment was made for the timing of acute rejection within the first year (rate ratio, 0.69; 95 percent confidence interval, 0.44 to 1.10; P=0.10). Increasing duration of dialysis was associated with increasing odds of rejection within six months after transplantation (P=0.001).Conclusions: Preemptive transplantation of kidneys from living donors without the previous initiation of dialysis is associated with longer allograft survival than transplantation performed after the initiation of dialysis. (N Engl J Med 2001;344:726-31.) Copyright (C) 2001 Massachusetts Medical Society.