Twelve years' experience with national sharing of HLA-matched cadaveric kidneys for transplantation
Twelve years' experience with national sharing of HLA-matched cadaveric kidneys for transplantation
复制标题
DOI：
10.1056/nejm200010123431504
复制
发表时间：
2000-10-12
影响因子：
158.5
通讯作者：
Cecka, JM
中科院分区：
文献类型：
--
作者：
Takemoto, SK;Terasaki, PI;Cecka, JM
背景资料：1987年10月，器官共享联合网络（United Network for Organ Sharing，UNOS）建立了一个国家肾脏共享计划，以增加HLA匹配移植的数量。从那时起，超过7500个尸体肾脏被运送到48个州的中心，用于移植给HLA匹配的患者。我们评估了该计划的有效性，在其第一个12年的operation.Methods：我们比较了排斥反应和精算移植物存活率为7614 HLA匹配和81,364 HLA不匹配的尸体肾移植报告的UNOS科学注册1987年10月和1999年9月之间。为了评估与运输HLA匹配的肾脏相关的缺血延长期的影响，我们确定了3562对尸体肾脏，其中一个肾脏去了HLA匹配的收件人和其他去了HLA不匹配的recipient.Results：估计10年的移植存活率为52%的HLA匹配的移植，相比之下，HLA不匹配的移植37%。移植物的估计半衰期分别为12.5年和8.6年，冷缺血的平均持续时间分别为23小时和22小时。在对人口统计学特征的影响进行调整后，10年时，HLA匹配移植的总移植物存活率和功能性移植物存活率（对功能性移植物死亡的患者进行数据删失）分别比HLA不匹配移植高10%和11%。在3562对肾脏，HLA匹配的移植有较高的生存率，排斥反应的发生率较低，和一个较低的风险损失作为reject.Conclusions的结果：一个上级移植结果与冷缺血的持续时间略有增加证明国家共享HLA匹配的肾移植。（N Engl J Med 2000;343：1078-84.）(C)2000年，马萨诸塞州医学会。
Background: In October 1987, the United Network for Organ Sharing (UNOS) established a national kidney-sharing program to increase the number of HLA-matched transplantations. Since then, over 7500 cadaveric kidneys have been shipped to centers in 48 states for transplantation to HLA-matched patients. We evaluated the efficacy of the program during its first 12 years of operation.Methods: We compared the rates of rejection and actuarial graft survival for 7614 HLA-matched and 81,364 HLA-mismatched cadaveric kidney transplantations reported to the UNOS Scientific Registry between October 1987 and September 1999. To assess the effects of the extended period of ischemia associated with shipping HLA-matched kidneys, we identified 3562 pairs of cadaveric kidneys in which one kidney went to an HLA-matched recipient and the other went to an HLA-mismatched recipient.Results: The estimated 10-year rate of graft survival was 52 percent for HLA-matched transplants, as compared with 37 percent for HLA-mismatched transplants. The estimated half-lives of the transplants were 12.5 years and 8.6 years, respectively, and the mean duration of cold ischemia was 23 hours and 22 hours, respectively. After adjustment for the effects of demographic characteristics, at 10 years the overall rates of graft survival and the rates of functional-graft survival (with data censored on patients who died with a functioning graft) were 10 percent and 11 percent higher, respectively, for HLA-matched transplants than for HLA-mismatched transplants. Among 3562 pairs of kidneys, HLA-matched transplants had higher rates of survival, a lower incidence of episodes of rejection, and a lower risk of loss as a result of rejection.Conclusions: A superior graft outcome with little increase in the duration of cold ischemia justifies national sharing of HLA-matched kidney transplants. (N Engl J Med 2000;343:1078-84.) (C) 2000, Massachusetts Medical Society.