Faster may be better for anastomosis time, but does it really affect survival?
Faster may be better for anastomosis time, but does it really affect survival?
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吻合时间越快可能越好，但这真的会影响生存吗？
DOI：
10.1111/tri.12546
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发表时间：
2015
期刊：
影响因子：
--
通讯作者：
O'Neill S
中科院分区：
文献类型：
--
作者：
O'Neill S
尊敬的先生们，我们祝贺Weissenbacher及其同事的回顾性研究，该研究考察了吻合时间（AT）对已故供体肾移植后结局的影响，标题为“越快越好”[1]。作者得出结论，AT与患者生存率独立相关，但与总移植物生存率无关，并建议AT是“最重要的可改变移植因素之一，应被视为长期结局的主要风险因素”。正如作者所提出的，由于AT时间延长而导致的热缺血增加可能直接导致患者死亡。第二种解释是，AT只是其他易导致患者死亡的因素的替代品。因此，在得出结论之前应谨慎，因为模型中的控制不足可能导致AT混淆。至少表面上难以通过所提出的机制来协调移植手术中导致患者死亡的事件，这对移植物存活没有显著影响。在196/1245例（15.7%）已知死亡中，据报告，仅12例（1%）移植物功能不全。目前尚不清楚这些患者是否在死亡前再次移植。吻合时间、移植物缺血和独立于移植物存活的患者死亡之间的机械联系不容易看到，特别是当考虑到死亡的主要原因是心力衰竭、败血症和癌症时。这将是有用的，以了解AT是否影响移植肾功能，确定估计肾小球滤过率或immunosuppression requirements.The分析患者死亡占供体和受体的年龄和体重指数，供体高血压，供体满足扩展标准。可能影响AT并与患者死亡相关的未考虑的手术和手术因素包括，例如，动脉粥样硬化和糖尿病中观察到的血管质量差、肾病原因、出血和手术技术差。
Dear Sirs, We congratulate Weissenbacher and colleagues on their retrospective study examining the influence of anastomosis time (AT) on outcomes after deceased donor kidney transplant, provocatively entitled ‘The Faster the Better’[1]. The authors conclude that AT is independently associated with patient survival, but not with overall graft survival, and suggest that AT is ‘one of the most important modifiable transplant factors [and] should be considered a major risk factor for long term outcome’. It may be the case that an increase in warm ischemia due to longer AT directly contributes to patient death, as the authors propose. A second explanation is that AT is simply a surrogate for other factors that predispose to patient death. Caution should therefore be exercised before drawing conclusions as insufficient controls within the models may lead to AT being confounded. It is at least superficially difficult to reconcile an event at the transplant procedure contributing to patient death by the mechanisms proposed, which does not have a significant effect on graft survival. Of the 196/1245 (15.7%) known deaths, it is reported that only 12 (1%) did not have a functioning graft. It is not clear whether any of these patients were retransplanted prior to death. A mechanistic link between anastomotic time, graft ischemia, and patient death that is independent of graft survival is not easy to see, particularly when considering the primary causes of death were heart failure, sepsis, and cancer. It would be useful to know whether AT influenced graft function as determined by estimated glomerular filtration rate or immunosuppression requirements.The analysis of patient death accounted for donor and recipient age and body mass index, donor hypertension, and donor fulfilling extended criteria. Recipient and operative factors not accounted for that may have impact on AT and be associated with patient death include, for instance, poor quality vessels seen in atherosclerosis and diabetes, cause of renal disease, bleeding, and poor surgical technique.
影响因子：
3.1
作者：
Weissenbacher, Annemarie;Oberhuber, Rupert;Oellinger, Robert
通讯作者：
Oellinger, Robert