Optimizing waiting duration for renal transplants in the setting of renal malignancy: is 2 years too long to wait?
Optimizing waiting duration for renal transplants in the setting of renal malignancy: is 2 years too long to wait?
复制标题
优化肾恶性肿瘤情况下肾移植的等待时间：等待 2 年是否太长？
DOI：
10.1093/ndt/gfx254
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发表时间：
2017
期刊：
影响因子：
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通讯作者：
Vourganti,Srinivas
中科院分区：
文献类型：
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作者：
Nguyen,KevinA;Syed,JamilS;Luciano,Randy;Shuch,Brian;Vourganti,Srinivas
背景对于有肾脏恶性肿瘤病史的潜在移植受者，目前还没有关于透析等待时间的循证建议。我们的目的是通过评估等待时间对等待肾移植的肾癌患者结局的影响来改善决策。方法使用美国肾脏数据系统来识别1983-2007年间已知的终末期肾病(ESRD)患者。采用Kaplan-Meier估计法和Cox比例风险模型对总生存期(OS)进行评估。采用精细灰色竞争风险模型评估肿瘤特异性死亡率和非肿瘤特异性死亡率。结果在1例 374 175例终末期肾病患者中，228例 984(16.7%)接受了移植。与其他已知原因的终末期肾病患者相比，患有肾脏恶性肿瘤相关性终末期肾病(RM-ESRD)的移植受者等待时间更长(2.4年对1.3年；P <； 0.0001)。等待时间较短(0-2 年)的RM-ESRD患者的OS好于等待时间较长(2年以上)的患者(10年OS分别为69.0%和46.7%；P <； 0.0001)，具有相似CSM的患者(10年CSM10.3%和10.2%；P = 0.883)，而等待时间较长的患者NCSM较差(10年NCSM20.7%和44.3%；P <； 0.0001)。在COX模型中，等待时间越长，等待时间越长，等待时间越短，等待时间越长，等待时间越短，等待时间越长，等待时间越长，等待时间越短，等待时间越长，等待时间越短，等待时间越短，等待时间越长，等待时间越短，等待时间越长，等待时间越短，等待时间越短，等待时间越长，等待时间越短，等待这些发现表明，通过减少等待时间，可能会改善患有RM-ESRD的潜在移植受者的OS。
BackgroundFor potential transplant recipients with a prior history of renal malignancy, no evidence-based recommendations currently exist with regard to waiting duration on dialysis. We aim to improve decision making by evaluating the impact of waiting duration on the outcomes of kidney cancer patients awaiting renal transplantation.MethodsThe United States Renal Data System was used to identify patients with a known cause of end-stage renal disease (ESRD) from 1983 to 2007. Evaluation of overall survival (OS) was performed with Kaplan–Meier estimates and Cox proportional hazards models. Fine–Gray competing risk models were used to assess cancer-specific mortality (CSM) and non-cancer-specific mortality (NCSM).ResultsOf 1 374 175 patients with ESRD, 228 984 (16.7%) received transplantation. Transplant recipients with renal malignancy–associated ESRD (RM-ESRD) had longer waiting durations than those with other known causes of ESRD (2.4 versus 1.3 years; P < 0.0001). RM-ESRD patients who had shorter waiting durations (0–2 years) had better OS than those who waited longer (2+ years) (10-year OS 69.0 versus 46.7%, respectively; P < 0.0001), with similar CSM (10-year CSM 10.3 versus 10.2%, respectively; P = 0.883), whereas NCSM was worse for those with longer waiting durations (10-year NCSM 20.7 versus 44.3%, respectively; P < 0.0001). On Cox modeling, the status of RM-ESRD was not a significant predictor (P = 0.07), while longer waiting duration remained significant (P < 0.0001).ConclusionWe found that CSM was not affected by waiting duration, while NCSM significantly improved with shorter wait times. These findings suggest that the OS of potential transplant recipients with RM-ESRD may be improved by reducing waiting duration.