Survival in recipients of marginal cadaveric donor kidneys compared with other recipients and wait-listed transplant candidates
Survival in recipients of marginal cadaveric donor kidneys compared with other recipients and wait-listed transplant candidates
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DOI：
10.1681/asn.v123589
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发表时间：
2001-03-01
影响因子：
13.6
通讯作者：
Port, FK
中科院分区：
文献类型：
--
作者：
Ojo, AO;Hanson, JA;Port, FK
越来越多的尸体肾脏移植手术现在使用的器官来自早期被认为不合适的捐赠者。尽管这些边缘供体移植获得了良好的同种异体移植结果，但目前尚不清楚边缘肾脏移植接受者是否能像“理想”肾脏接受者那样降低长期死亡率。1992年1月1日至1997年6月30日期间登记在尸体肾移植等待名单上的终末期肾病患者，根据三种结果研究了死亡风险：未移植的透析治疗等待名单（WLD）；边缘供肾移植（MDK）；以及“理想”或最佳供体肾移植（IDK）。截至1998年6月30日，34%的等候名单登记者接受了尸体肾脏移植。其中，18%的患者接受的边缘肾有以下一个或多个移植前因素：供者年龄bbbb55岁，供者无心脏跳动，冷缺血时间bbbb36小时，供者高血压或糖尿病持续b>0年。MDK受体的5年移植和患者生存率分别为53%和74%，而IDK受体的5年移植和患者生存率分别为67% （P < 0.001）和80% （P < 0.001）。WLD、MDK和IDK组的调整后年死亡率和估计剩余寿命分别为6.3%、4.7%和3.3%，15.3年、20.4年和28.7年。与WLD队列相比，MDK接受者的平均预期寿命增加了5年，尽管根据接受者的特点，这种获益从3年到10年不等。结论是，与维持性透析相比，边缘肾移植与显著的生存获益相关。
An increasing number of cadaveric kidney transplants are now performed with organs from donors who would have been deemed unsuitable in earlier times. Although good allograft outcomes have been obtained with these marginal donor transplants, it is unclear whether recipients of marginal kidney transplants achieve a reduction in long-term mortality as do recipients of "ideal" kidneys. Patients with end-stage renal disease registered on the cadaveric renal transplant waiting list between January 1, 1992, and June 30, 1997, were studied for mortality risks according to three outcomes: wait-listed on dialysis treatment with no transplant (WLD); transplantation with marginal donor kidney (MDK); and "ideal" or optimal donor kidney transplantation (IDK). Thirty-four percent of wait-list registrants had received a cadaveric kidney transplant by June 30, 1998. Of these, 18% received a marginal kidney that had one or more of the following pretransplant factors: donor age >55 yr, non-heartbeating donor, cold ischemia time >36 h, and donor hypertension or diabetes mellitus of >10 yr duration. Five-year graft and patient survival was 53% and 74% for MDK recipients compared with 67% (P < 0.001) and 80% (P < 0.001) for IDK recipients. Adjusted annual death rate and estimated remaining life time was 6.3%, 4.7%, and 3.3% and 15.3 yr, 20.4 yr, and 28.7 yr for WLD, MDK, and IDK groups, respectively. The average increase in life expectancy for MDK recipients compared with the WLD cohort was 5 yr, although this benefit Varied from 3 to 10 yr depending on the recipient's characteristics. It is concluded that transplantation of a marginal kidney is associated with a significant survival benefit when compared with maintenance dialysis.