Renal allograft loss due to renal vascular thrombosis in the US pediatric renal transplantation.
Renal allograft loss due to renal vascular thrombosis in the US pediatric renal transplantation.
复制标题
美国小儿肾移植中因肾血管血栓形成导致肾同种异体移植损失。
DOI：
10.1007/s00467-019-04264-0
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发表时间：
2019
期刊：
影响因子：
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通讯作者：
Hogan,Julien
中科院分区：
文献类型：
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作者：
Wang,Chia-Shi;Greenbaum,LarryA;Patzer,RachelE;Garro,Rouba;Warshaw,Barry;George,RoshanP;Winterberg,PamelaD;Patel,Kavita;Hogan,Julien
背景肾血管血栓（RVT）是小儿肾移植后第一年早期同种异体移植物丢失的主要原因。我们检查了 RVT 导致的同种异体移植物丢失的最新趋势，并确定了相关的危险因素。方法我们从美国肾脏数据系统中确定了 1995 年至 2014 年间进行的 14,640 例仅肾脏移植手术，并随访至 2016 年 6 月 30 日，涉及 13,758 名年龄 <19 岁的儿科患者。我们按移植年份检查了因 RVT 导致的同种异体移植物丢失的 1 年发生率，并绘制了随时间变化的趋势。 Cox比例风险模型用于研究移植年份以及受者、供体和移植特征与RVT导致的同种异体移植物丢失之间的关系。结果在1995年至2014年期间进行的儿童肾移植中，RVT导致的同种异体移植物丢失发生率持续下降。在1995年至2004年期间进行的移植中，与2014年相比，128/7542（1.7％）同种异体移植物由于RVT而丢失2005 年至 2014 年期间进行的移植手术中有 53/7098 (0.8%)；平均 1 年累积发生率分别为 1.5%（95% CI，1.3-1.9%）和 0.6%（95% CI，0.5-0.8%）。 RVT 导致同种异体移植物丢失的风险增加与整块肾移植（HR，3.42；95% CI 1.38–8.43）和冷缺血时间≥ 12 h（HR，1.78；95% CI，1.15–2.76）相关。有趣的是，这些危险因素在后十年更为普遍。 结论 在 1995 年至 2014 年间进行的儿童肾移植中，RVT 导致的同种异体移植物丢失的发生率显着持续下降。目前的分析尚不清楚这种改善的原因。
BackgroundRenal vascular thrombosis (RVT) is a major cause of early allograft loss in the first year following pediatric kidney transplantation. We examined recent trends in allograft loss due to RVT and identified associated risk factors.MethodsWe identified 14,640 kidney-only transplants performed between 1995 and 2014 with follow-up until June 30, 2016, in 13,758 pediatric patients aged < 19 years from the US Renal Data System. We examined the 1-year incidence of allograft loss due to RVT by year of transplant, and plotted the trend over time. Cox proportional hazards models were used to investigate the relationship between year of transplant as well as recipient, donor, and transplant characteristics with allograft loss due to RVT.ResultsThe incidence of allograft loss due to RVT consistently declined among pediatric kidney transplant performed between 1995 and 2014. Among transplants performed between 1995 and 2004, 128/7542 (1.7%) allografts were lost due to RVT compared to 53/7098 (0.8%) among transplants performed between 2005 and 2014; average 1-year cumulative incidence was 1.5% (95% CI, 1.3–1.9%) and 0.6% (95% CI, 0.5–0.8%), respectively. Increased risk for allograft loss due to RVT was associated with en bloc kidney transplantation (HR, 3.42; 95% CI 1.38–8.43) and cold ischemia time ≥ 12 h (HR, 1.78; 95% CI, 1.15–2.76). Interestingly, these risk factors were more prevalent in the latter decade.ConclusionsThe incidence of allograft loss due to RVT significantly and continuously declined among pediatric kidney transplants performed between 1995 and 2014. The causes for this improvement are unclear in the present analysis.