The UK kidney donor risk index poorly predicts long-term transplant survival in paediatric kidney transplant recipients.
The UK kidney donor risk index poorly predicts long-term transplant survival in paediatric kidney transplant recipients.
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DOI：
10.3389/fimmu.2023.1207145
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发表时间：
2023
影响因子：
7.3
通讯作者：
中科院分区：
文献类型：
--
作者：
英国肾脏捐赠计划引入了肾脏捐赠者风险指数（UK-KDRI），以提高已故捐赠者肾脏分配的效用。UK-KDRI是使用成人供体和受体数据得出的。我们在英国移植登记处的儿科队列中对此进行了评估。我们对2000年至2014年儿科（<18岁）接受者中的首次仅肾脏死亡脑死亡移植进行了考克斯生存分析。主要结局是移植后死亡删失的同种异体移植物存活>30天。主要研究变量是UK-KDRI，来自7个供体风险因素，分为4组（D1-低风险，D2，D3和D4-最高风险）。随访于2021年12月31日结束。319/908例患者发生移植失败，排斥反应是主要原因（55%）。大多数儿科患者接受来自D1供体的供体（64%）。在研究期间，D2-4供体增加，而HLA错配水平提高。KDRI与同种异体移植失败无关。在多变量分析中，增加受体年龄[校正的HR和95%CI：1.05（1.03-1.08）每年，p<0.001]，接受者少数民族组[1.28（1.01-1.63），p<0.05），移植前透析[1.38（1.04-1.81），p<0.005]，供体身高[0.99（0.98-1.00）/cm，p<0.05]和HLA错配水平[3级：1.92（1.19-3.11）; 4级：2.40（1.26-4.58）vs 1级，p<0.01]与更差的结果相关。HLA 1级和2级错配（0 DR +0/1 B错配）患者的移植物中位生存期>17年，与UK-KDRI组无关。供体年龄的增加与同种异体移植物存活率的降低略有相关[1.01（1.00-1.01）/年，p=0.05]。成人供体风险评分与儿科患者的长期同种异体移植物存活率无关。HLA错配水平对生存率的影响最大。仅基于成人数据的风险模型可能对儿科患者不具有相同的有效性，因此所有年龄组都应纳入未来的风险预测模型。
The UK kidney offering scheme introduced a kidney donor risk index (UK-KDRI) to improve the utility of deceased-donor kidney allocations. The UK-KDRI was derived using adult donor and recipient data. We assessed this in a paediatric cohort from the UK transplant registry. We performed Cox survival analysis on first kidney-only deceased brain-dead transplants in paediatric (<18 years) recipients from 2000-2014. The primary outcome was death-censored allograft survival >30 days post-transplant. The main study variable was UK-KDRI derived from seven donor risk-factors, categorised into four groups (D1-low risk, D2, D3 and D4-highest risk). Follow-up ended on 31-December-2021. 319/908 patients experienced transplant loss with rejection as the main cause (55%). The majority of paediatric patients received donors from D1 donors (64%). There was an increase in D2-4 donors during the study period, whilst the level of HLA mismatching improved. The KDRI was not associated with allograft failure. In multi-variate analysis, increasing recipient age [adjusted HR and 95%CI: 1.05(1.03-1.08) per-year, p<0.001], recipient minority ethnic group [1.28(1.01-1.63), p<0.05), dialysis before transplant [1.38(1.04-1.81), p<0.005], donor height [0.99 (0.98-1.00) per centimetre, p<0.05] and level of HLA mismatch [Level 3: 1.92(1.19-3.11); Level 4: 2.40(1.26-4.58) versus Level 1, p<0.01] were associated with worse outcomes. Patients with Level 1 and 2 HLA mismatches (0 DR +0/1 B mismatch) had median graft survival >17 years regardless of UK-KDRI groups. Increasing donor age was marginally associated with worse allograft survival [1.01 (1.00-1.01) per year, p=0.05]. Adult donor risk scores were not associated with long-term allograft survival in paediatric patients. The level of HLA mismatch had the most profound effect on survival. Risk models based on adult data alone may not have the same validity for paediatric patients and therefore all age-groups should be included in future risk prediction models.
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影响因子：
6.2
作者：
Opelz, Gerhard;Doehler, Bernd
通讯作者：
Doehler, Bernd
影响因子：
6.1
作者：
Kramer, Anneke;Stel, Vianda S.;Jager, Kitty J.
通讯作者：
Jager, Kitty J.
影响因子：
8.8
作者：
Jackson, Kyle R.;Zhou, Sheng;Garonzik-Wang, Jacqueline
通讯作者：
Garonzik-Wang, Jacqueline
影响因子：
6.2
作者：
Parker WF;Thistlethwaite JR Jr;Ross LF
通讯作者：
Ross LF
影响因子：
6.2
作者：
Meier-Kriesche, Herwig-Ulf;Scornik, Juan C.;Schold, Jesse D.
通讯作者：
Schold, Jesse D.