Time-dependent risk factors influencing the long-term outcome in living renal allografts: donor age is a crucial risk factor for long-term graft survival more than 5 years after transplantation.
Time-dependent risk factors influencing the long-term outcome in living renal allografts: donor age is a crucial risk factor for long-term graft survival more than 5 years after transplantation.
复制标题
影响活体肾同种异体移植物长期结果的时间依赖性危险因素：供体年龄是移植物移植后 5 年以上长期存活的关键危险因素。
作者：
H. Toma;K. Tanabe;T. Tokumoto;Tomokazu Shimizu;H. Shimmura
背景
大多数研究表明，早期移植物存活率的改善并没有导致移植物长期存活率的相应改善。移植物长期存活的危险因素应该明确。
方法
回顾了1983年至1998年连续1100例接受活体供肾的肾移植受者的单中心经验，以阐明长期移植物存活的风险因素的时间依赖性。我们采用时间依赖的非比例考克斯风险模型，研究了各种可能的风险因素，包括HLA-AB和-DR错配、ABO血型不合、移植物重量、供体年龄和性别、受体年龄和性别以及是否存在急性排斥反应。
结果
急性排斥反应、供者年龄、HLA-AB 4抗原错配、ABO血型不合移植、肾重小于患者体重（Kw/Bw比值小于2.67）和来自无关活体供者的移植是长期移植结局的危险因素。时间依赖性危险因素的多因素分析显示，供体年龄超过60岁是移植后5年长期移植失败的最重要危险因素（风险比：2.57）。相反，急性排斥反应、ABO血型不合和非亲缘供者是肾移植后5年内短期移植物衰竭的重要危险因素（危险比分别为2.68、1.57和1.69）。
结论
供体年龄超过60岁是影响移植物长期存活的关键危险因素。相反，急性排斥反应、ABO血型不合和非亲缘供者是短期移植失败的重要危险因素。
BACKGROUND
Most investigations have revealed that the improvement in early graft survival has not resulted in a corresponding improvement in long-term graft survival. The risk factors for long-term graft survival should be clarified.
METHODS
A single-center experience of 1100 consecutive renal transplant recipients who received kidneys from living donors from 1983 to 1998 was reviewed to clarify the time dependency of risk factors for long-term graft survival. We examined various possible risk factors, including HLA-AB and -DR mismatches, ABO-blood group incompatibility, graft weight, donor age and sex, recipient age and sex, and the presence or absence of acute rejection by using the time-dependent, nonproportional Cox's hazards model.
RESULTS
Acute rejection episode, donor age, HLA-AB 4-antigen mismatches, ABO-incompatible transplantation, smaller kidney weight compared with the patient's body weight (Kw/Bw ratio less than 2.67), and transplantation from an unrelated living donor were risk factors for long-term graft outcome. Multivariate analysis for time-dependent risk factors showed that donor age of more than 60 years was the most important risk factor for long-term graft failure after 5 years posttransplantation (hazard ratio: 2.57). In contrast, acute rejection, ABO incompatibility, and nonrelated donors were significant risk factors for short-term graft failure within 5 years after kidney transplantation (hazard ratios: 2.68, 1.57, and 1.69, respectively).
CONCLUSIONS
Donor age of more than 60 years was a crucial risk factor affecting long-term graft survival. In contrast, acute rejection, ABO incompatibility, and nonrelated donors were significant risk factors for short-term graft failure.
影响因子：
158.5
作者：
Hariharan, S;Johnson, CP;Stablein, D
通讯作者：
Stablein, D
慢性同种异体移植排斥反应。
影响因子：
6.2
作者：
Shirwan,H
通讯作者：
Shirwan,H