Improved graft survival after renal transplantation in the United States, 1988 to 1996.
Improved graft survival after renal transplantation in the United States, 1988 to 1996.
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DOI：
10.1056/nejm200003023420901
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发表时间：
2000-03-02
影响因子：
158.5
通讯作者：
Stablein, D
中科院分区：
文献类型：
--
作者：
Hariharan, S;Johnson, CP;Stablein, D
背景资料：环孢素的引入改善了肾移植的短期结果，但其对肾移植患者长期存活的影响尚不清楚。方法：我们分析了人口统计学特征的影响（年龄、性别和种族），移植相关变量（活体或尸体供体、群体反应性抗体滴度、HLA匹配程度和冷缺血时间），和移植后变量（存在或不存在急性排斥反应，移植物功能延迟，以及用吗替麦考酚酯和他克莫司治疗）对1988年至1996年间在美国进行的所有93，934例肾移植的移植物存活率的影响。一个回归分析调整这些变量被用来估计移植失败的风险在第一年内，超过一年后transplant.Results：从1988年至1996年，一年的存活率从88.8%增加到93.9%，从75.7%增加到87.7%的尸体移植。活体移植物的半衰期从12.7年稳步增加到21.6年，尸体移植物的半衰期从7.9年增加到13.8年。在对移植物功能正常的死亡患者的数据进行删失后，活体供体移植物的半衰期从16.9年增加到35.9年，尸体移植物的半衰期从11.0年增加到19.5年。对于所有受体，一年后移植失败的相对风险平均每年降低4.2%（P
Background: The introduction of cyclosporine has resulted in improvement in the short-term outcome of renal transplantation, but its effect on the long-term survival of kidney transplants is not known.Methods: We analyzed the influence of demographic characteristics (age, sex, and race), transplant-related variables (living or cadaveric donor, panel-reactive antibody titer, extent of HLA matching, and cold-ischemia time), and post-transplantation variables (presence or absence of acute rejection, delayed graft function, and therapy with mycophenolate mofetil and tacrolimus) on graft survival for all 93,934 renal transplantations performed in the United States between 1988 and 1996. A regression analysis adjusted for these variables was used to estimate the risk of graft failure within the first year and more than one year after transplantation.Results: From 1988 to 1996, the one-year survival rate for grafts from living donors increased from 88.8 to 93.9 percent, and the rate for cadaveric grafts increased from 75.7 to 87.7 percent. The half-life for grafts from living donors increased steadily from 12.7 to 21.6 years, and that for cadaveric grafts increased from 7.9 to 13.8 years. After censoring of data for patients who died with functioning grafts, the half-life for grafts from living donors increased from 16.9 years to 35.9 years, and that for cadaveric grafts increased from 11.0 years to 19.5 years. The average yearly reduction in the relative hazard of graft failure after one year was 4.2 percent for all recipients (P