HIGH SURVIVAL RATES OF KIDNEY-TRANSPLANTS FROM SPOUSAL AND LIVING UNRELATED DONORS
HIGH SURVIVAL RATES OF KIDNEY-TRANSPLANTS FROM SPOUSAL AND LIVING UNRELATED DONORS
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DOI：
10.1056/nejm199508103330601
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发表时间：
1995-08-10
影响因子：
158.5
通讯作者：
TAKEMOTO, S
中科院分区：
文献类型：
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作者：
TERASAKI, PI;CECKA, JM;TAKEMOTO, S
背景在美国，越来越多的人捐赠肾脏给他们的配偶，尽管更大的组织不相容性，这些肾脏的存活率高于尸体肾脏。我们研究了影响配偶供肾高存活率的因素。采用Kaplan-Meier分析法计算联合器官共享网络肾移植登记处的肾移植数据。来自368名配偶的肾脏的三年存活率为85%，来自129名未与受体结婚的活体无关捐赠者的肾脏的三年存活率为81%，来自3368名父母的肾脏的三年存活率为82%，来自43，341名尸体肾脏的三年存活率为70%。妻子对丈夫移植的三年存活率为87%，如果妻子从未怀孕，这与丈夫对妻子移植的三年存活率相同。如果妻子以前怀孕过，三年移植物存活率为76%（P = 0.40）。术前未接受输血的配偶移植受体的3年移植物存活率为81%，而术前接受1 - 10次输血的受体的3年移植物存活率为90%（P = 0.008）。无关供体的移植物的上级存活率不能归因于更好的HLA配型、白色人种、更年轻的供体年龄或更短的冷缺血时间，但可能是由于10%的尸体肾在取出前休克造成的损伤。配偶是活体供肾移植的重要来源，因为尽管HLA配型较差，但移植物存活率与父母供肾相似。这种高存活率归因于肾脏一致健康的事实。
Background. In the United States, increasing numbers of persons are donating kidneys to their spouses, Despite greater histoincompatibility, the survival rates of these kidneys are higher than those of cadaveric kidneys. We examined the factors influencing the high survival rates of spousal-donor kidneys.Methods. Kidney-transplant data from the United Network for Organ Sharing Renal Transplant Registry were used to calculate graft-survival rates with Kaplan-Meier analysis.Results. The three-year survival rates were 85 percent for kidneys from 368 spouses, 81 percent for kidneys from 129 living unrelated donors who were not married to the recipients, 82 percent for kidneys from 3368 parents, and 70 percent for 43,341 cadaveric kidneys. The three-year survival rate for wife-to-husband grafts was 87 percent, which was the same as for husband-to-wife grafts if the wife had never been pregnant. If the wife had previously been pregnant, the three-year graft-survival rate was 76 percent (P = 0.40). The three-year graft-survival rate among recipients of spousal grafts who did not receive transfusions preoperatively was 81 percent, as compared with 90 percent for recipients who received 1 to 10 transfusions preoperatively (P = 0.008). The superior survival rate of grafts from unrelated donors could not be attributed to better HLA matching, white race, younger donor age, or shorter cold-ischemia times, but might be explained by damage due to shock before removal in 10 percent of the cadaveric kidneys.Conclusions. Spouses are an important source of living-donor kidney grafts because, despite poor HLA matching, the graft-survival rate is similar to that of parental-donor kidneys. This high rate of survival is attributed to the fact that the kidneys were uniformly healthy.