Deceased-donor characteristics and the survival benefit of kidney transplantation
Deceased-donor characteristics and the survival benefit of kidney transplantation
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DOI：
10.1001/jama.294.21.2726
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发表时间：
2005-12-07
影响因子：
120.7
通讯作者：
Port, FK
中科院分区：
文献类型：
--
作者：
Merion, RM;Ashby, VB;Port, FK
背景 与非 ECD 移植相比，使用符合扩展标准供体 (ECD) 定义的已故供体（年龄 >= 60 岁或 50 至 59 岁，且至少具有以下 2 种情况：高血压病史、血清肌酐水平 >1.5 mg/dL [132.6 mu mol/L] 和脑血管死因）的肾脏移植，移植失败的风险高出 70%。然而，如果 ECD 移植能改善患者的总体生存率，那么较差的移植结果可能代表可接受的权衡。 目的 比较 ECD 肾移植后的死亡率与非 ECD 受者和仍在接受透析的联合标准治疗组的死亡率。 设计、环境和患者回顾性队列研究使用来自美国国家肾移植候选者和受者死亡率和移植结果登记处的数据。该队列包括 109 127 名接受透析并在 1995 年 1 月 1 日至 2002 年 12 月 31 日期间添加到肾脏等待名单中的患者，并随访至 2004 年 7 月 31 日。 主要结果测量 ECD 肾接受者与接受标准治疗的患者的长期（3 年）相对死亡风险，使用时间依赖性 Cox 回归模型进行估计。 结果 随访结束时，7790 名患者进行了 ECD 肾移植。由于围手术期 ECD 受者死亡率过高，直到移植后 3.5 年，累积生存率才与标准治疗患者的生存率持平。 ECD 接受者的长期相对死亡风险降低 17%（相对风险，0.83；95% 置信区间，0.77-0.90-，P1350 天），ECD 接受者的死亡风险降低 27%（相对风险，0.73；95% 置信区间，0..64-0.83；P
Context Transplantation using kidneys from deceased donors who meet the expanded criteria donor (ECD) definition (age >= 60 years or 50 to 59 years with at least 2 of the following: history of hypertension, serum creatinine level >1.5 mg/dL [132.6 mu mol/L], and cerebrovascular cause of death) is associated with 70% higher risk of graft failure compared with non-ECD transplants. However, if ECD transplants offer improved overall patient survival, inferior graft outcome may represent an acceptable trade-off.Objective To compare mortality after ECD kidney transplantation vs that in a combined standard-therapy group of non-ECD recipients and those still receiving dialysis.Design, Setting, and Patients Retrospective cohort study using data from a US national registry of mortality and graft outcomes among kidney transplant candidates and recipients. The cohort included 109 127 patients receiving dialysis and added to the kidney waiting list between January 1, 1995, and December 31, 2002, and followed up through July 31, 2004.Main Outcome Measure Long-term (3-year) relative risk of mortality for ECD kidney recipients vs those receiving standard therapy, estimated using time-dependent Cox regression models.Results By end of follow-up, 7790 ECD kidney transplants were performed. Because of excess ECD recipient mortality in the perioperative period, cumulative survival did not equal that of standard-therapy patients until 3.5 years posttransplantation. Long-term relative mortality risk was 17% lower for ECD recipients (relative risk, 0.83; 95% confidence interval, 0.77-0.90-, P1350 days), ECD recipients had a 27% lower risk of death (relative risk, 0.73; 95% confidence interval, 0..64-0.83; P