Solid Organ Allograft Survival Improvement in the United States: The Long-Term Does Not Mirror the Dramatic Short-Term Success
Solid Organ Allograft Survival Improvement in the United States: The Long-Term Does Not Mirror the Dramatic Short-Term Success
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DOI：
10.1111/j.1600-6143.2011.03539.x
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发表时间：
2011-06-01
影响因子：
8.8
通讯作者：
Meier-Kriesche, H. U.
中科院分区：
文献类型：
--
作者：
Lodhi, S. A.;Lamb, K. E.;Meier-Kriesche, H. U.
在过去的几十年里，移植后短期内的器官存活率有了显着提高。这是否会转化为长期生存获益仍不清楚。这项研究量化了 1989 年至 2009 年肝、肺、心脏、肠和胰腺移植中非肾实体器官移植结果的进展。使用 UNOS/SRTR 数据库中成人实体器官移植受者的数据对长期移植物存活率进行分析，并报告为器官半衰期和每年损耗率。肝脏、肺、心脏、肠和胰腺的半衰期分别从5.8年延长至8.5年、1.7年延长至5.2年、8.8年延长至11年、2.1年延长至3.6年和10.5年延长至16.7年。长期损耗率并未显示出同样一致的改善，肝、肺、心脏和胰腺移植后 5-10 年的年损耗率分别从 4.7 变为 4.3、10.9 变为 10.1、6.4 变为 5.1 和 3.3 变为 4.2。由于样本量较小，仅肠和胰腺移植的损耗率就表现出更大的变异性，但表现出类似的第一年损耗率改善和相对停滞的长期损耗率的趋势。由于第一年生存率和自然损耗率几乎达到顶峰，长期生存率的进一步进展将来自于第一年排斥率和生存率之外的目标终点。
Organ survival in the short-term period post-transplant has improved dramatically over the past few decades. Whether this has translated to a long-term survival benefit remains unclear. This study quantifies the progression of nonrenal solid organ transplant outcomes from 1989 to 2009 in liver, lung, heart, intestine and pancreas transplants. Long-term graft survival was analyzed using data on adult solid organ transplant recipients from the UNOS/SRTR database and is reported as organ half-life and yearly attrition rates. Liver, lung, heart, intestine and pancreas half-lives have improved from 5.8 to 8.5, 1.7 to 5.2, 8.8 to 11, 2.1 to 3.6 and 10.5 to 16.7 years, respectively. Long-term attrition rates have not shown the same consistent improvement, with the yearly attrition rate 5-10 years post-transplant for liver, lung, heart and pancreas changing from 4.7 to 4.3, 10.9 to 10.1, 6.4 to 5.1 and 3.3 to 4.2, respectively. Attrition rates for intestine and pancreas transplantation alone display more variability due to smaller sample size but exhibit similar trends of improved first-year attrition and relatively stagnant long-term attrition rates. With first-year survival and attrition rates almost at a pinnacle, further progress in long-term survival will come from targeting endpoints beyond first-year rejection and survival rates.