Comparison of mortality in all patients on dialysis, patients on dialysis awaiting transplantation, and recipients of a first cadaveric transplant.
Comparison of mortality in all patients on dialysis, patients on dialysis awaiting transplantation, and recipients of a first cadaveric transplant.
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DOI：
10.1056/nejm199912023412303
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发表时间：
1999-12-02
影响因子：
158.5
通讯作者：
Port, FK
中科院分区：
文献类型：
--
作者：
Wolfe, RA;Ashby, VB;Port, FK
背景：与长期透析相比，同种异体肾移植在多大程度上提高了终末期肾病患者的存活率仍存在争议，因为选择移植的患者死亡风险可能较低。方法：为了区分患者选择和移植本身的影响，我们对228,552名接受长期透析的终末期肾病患者的死亡率进行了纵向研究。在这些患者中，46,164人被列入等待移植的名单，其中23,275人在1991年至1997年期间接受了首次身体移植。根据年龄、种族、性别、终末期肾病病因、地理区域、从首次治疗终末期肾病到被列入候补名单的时间和首次被列入名单的时间，用时间依赖的非比例风险分析评估死亡和存活的相对风险。结果：在各个亚组中，等待移植的透析患者的标化死亡率(年死亡率，6.3/100患者年)比所有透析患者(年死亡率，16.1/100患者年)低38%~58%。移植后前2周死亡的相对危险度是那些在等待名单上有相同随访期的透析患者的2.8倍，但在18个月时死亡的风险要低得多(相对危险度，0.32；95%可信区间，0.30~0.35；P
Background: The extent to which renal allotransplantation -- as compared with long-term dialysis -- improves survival among patients with end-stage renal disease is controversial, because those selected for transplantation may have a lower base-line risk of death.Methods: In an attempt to distinguish the effects of patient selection from those of transplantation itself, we conducted a longitudinal study of mortality in 228,552 patients who were receiving long-term dialysis for end-stage renal disease. Of these patients, 46,164 were placed on a waiting list for transplantation, 23,275 of whom received a first cadaveric transplant between 1991 and 1997. The relative risk of death and survival were assessed with time-dependent nonproportional-hazards analysis, with adjustment for age, race, sex, cause of end-stage renal disease, geographic region, time from first treatment for end-stage renal disease to placement on the waiting list, and year of initial placement on the list.Results: Among the various subgroups, the standardized mortality ratio for the patients on dialysis who were awaiting transplantation (annual death rate, 6.3 per 100 patient-years) was 38 to 58 percent lower than that for all patients on dialysis (annual death rate, 16.1 per 100 patient-years). The relative risk of death during the first 2 weeks after transplantation was 2.8 times as high as that for patients on dialysis who had equal lengths of follow-up since placement on the waiting list, but at 18 months the risk was much lower (relative risk, 0.32; 95 percent confidence interval, 0.30 to 0.35; P