Functional status-based risk-benefit analyses of high-KDPI kidney transplant versus dialysis
Functional status-based risk-benefit analyses of high-KDPI kidney transplant versus dialysis
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DOI：
10.1111/tri.13483
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发表时间：
2019-07-31
影响因子：
3.1
通讯作者：
Mehrotra, Sanjay
中科院分区：
文献类型：
--
作者：
Bui, Kevin;Kilambi, Vikram;Mehrotra, Sanjay
每年，超过一半的已故供者肾脏捐赠者的肾脏供体指数(KDPI)>；85被丢弃，但它们可以改善透析患者的生存结果。高KDPI肾移植(KT)的潜在风险取决于患者根据功能状态总结的整体健康状况，这一点应该进行检查。分析的队列包括2005-2014年间列出的接受透析的成年已故捐赠者KT候选人。用卡诺夫斯基绩效评分(KPS)测量的功能状态和移植状态作为时变协变量，对多变量Cox比例风险模型进行了拟合。根据COX模型分析生存曲线，比较透析和移植肾质量不同的患者在三个不同的KPS水平：10-40、50-70和80-100的生存结果。KDPI为0-99kT时，KPS 10-40患者的生存时间中位数为4.38年，而继续透析的患者存活时间中位数为3.21年。对于KPS 50以上的患者，中位生存期从透析时的5.82年增加到透析后的7.83年。风险调整后的分析表明，患者从KDPI 81-99KT中预计将比继续接受透析受益更多。
Yearly, over half of deceased-donor kidneys with kidney donor profile index (KDPI) > 85 were discarded, yet they could improve survival outcomes for dialysis patients. The potential risk of high-KDPI kidney transplant (KT) depends on the patient's overall health summarized by functional status, which should be examined. The analyzed cohort consisted of adult deceased-donor KT candidates on dialysis listed in 2005-2014. A multivariate Cox proportional hazards model was fitted with functional status, measured using Karnofsky Performance Score (KPS), and transplant status as time-varying covariates. Derived from the Cox model, survival curves were analyzed to compare the survival outcomes between dialysis and transplant with different kidney qualities across three different KPS strata: 10-40, 50-70, and 80-100. With KDPI 0-99 KT, KPS 10-40 patients will survive >= 4.38 years median compared with 3.21 years median if they remained on dialysis. For KPS 50+ patients, the median survival years increase from 5.82 to 6.60 years on dialysis to >= 7.83 years after KDPI KT. The risk-adjusted analyses suggested that patients are expected to benefit more from KDPI 81-99 KT than from remaining on dialysis.