Kidney Transplantation in Patients with Type 1 Diabetes Mellitus: Long-Term Prognosis for Patients and Grafts
Kidney Transplantation in Patients with Type 1 Diabetes Mellitus: Long-Term Prognosis for Patients and Grafts
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1 型糖尿病患者的肾移植：患者和移植物的长期预后
DOI：
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发表时间：
2001
期刊：
影响因子：
--
通讯作者：
J. Cheigh
中科院分区：
文献类型：
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作者：
Hyang Kim;J. Cheigh
肾移植是提高终末期糖尿病肾病患者存活率和生活质量的最佳治疗选择。然而，接受肾移植的糖尿病患者的长期预后尚未被描绘出来。因此，我们研究了纽约罗戈辛研究所/威尔-康奈尔医学中心78名I型糖尿病肾移植受者的患者和移植物存活率、移植物功能和移植物失败的原因，这些受者的移植物功能正常超过一年。将结果与78例非糖尿病患者进行比较，这些患者的移植物功能正常超过一年，并在年龄、性别、供体来源、移植时间和免疫抑制治疗方案方面匹配。糖尿病患者的累积患者存活率显著低于非糖尿病患者(5年分别为86%和97%，10年分别为74%和95%：P<；0.05)。最常见的死因是心血管疾病。糖尿病患者的移植物存活率也低于非糖尿病患者(5年分别为71%和80%，10年分别为58%和72%)，但差异没有统计学意义。在糖尿病患者的22例移植失败中，7例(32%)是由于患者死亡而不是原发移植失败。如果对死于功能正常的移植物的患者进行审查，糖尿病患者的移植物存活率接近非糖尿病患者(5年分别为80%和81%，10年分别为65%和73%)。在随访期内，糖尿病患者的肌酐清除量低于非糖尿病患者，但仅在最初几年差异显著。糖尿病患者的内生肌酐清除量从未出现过较高的水平。在移植后两到七年接受移植肾活检的16名患者中，有6名患者的肾脏形态变化与糖尿病肾病一致。1例患者仅因糖尿病肾病复发而丧失移植物功能。我们的结论是，糖尿病患者的长期存活率显著低于非糖尿病患者，这主要是由于心血管疾病。移植物存活率在两组之间是相当的。糖尿病患者的内生肌酐清除率低于非糖尿病患者。糖尿病患者在任何时候都不存在明显的肾小球高滤过。糖尿病肾病的复发是移植后10年内移植物失败的罕见原因。积极干预以改变心血管危险因素应能改善糖尿病肾移植受者的患者和移植物存活率。
Kidney transplantation is the best therapeutic choice to improve survival and quality of life in patients with end-stage diabetic nephropathy. Long-term prognosis in diabetic patients who received kidney transplants, however, has not been delineated. We, therefore, studied patient and graft survival, graft function and cause of graft failure in 78 Type I diabetic kidney transplant recipients in The Rogosin Institute/The Weill-Cornell Medical Center, New York who had functioning grafts for more than one year. The results were compared with 78 non-diabetic patients who had functioning grafts for more than one year and were matched for age, gender, donor source, time of transplantation and immunosuppressive therapy protocol. Cumulative patient survival rates for diabetic patients were significantly lower than those of non-diabetic patients (86% vs. 97% at 5 years and 74% vs. 95% at 10 years, respectively: p<0.05). The most common cause of death was cardiovascular disease. Graft survival rates for diabetic patients were also lower than that of non-diabetic patients (71% vs. 80% at 5 years and 58% vs. 72% at 10 years, respectively), but the differences did not reach statistical significance. Among the 22 failed grafts in diabetic patients, 7 (32%) were due to patient death rather than primary graft failure. If the patients who died with a functioning graft were censored, graft survival rates of diabetic patients approached those of non-diabetic patients (80% vs. 81% at 5 years and 65% vs. 73% at 10 years, respectively). Creatinine clearances in diabetic patients were lower than that in non-diabetic patients through the follow-up period, but the differences were significant only for the first few years. At no time was there a higher creatinine clearance for diabetic patients. Among the 16 patients who had transplant kidney biopsies two to seven years post-transplant, 6 showed morphological changes consistent with diabetic nephropathy. One patient lost graft function solely by recurrent diabetic nephropathy. We conclude that long-term patient survival for diabetic patients is significantly lower than that of non-diabetic patients, due primarily to cardiovascular disease. Graft survival is comparable between the two groups. Creatinine clearances of diabetic patients are lower than those of non-diabetic patients. There is no apparent glomerular hyperfiltration at any time in diabetic patients. Recurrence of diabetic nephropathy is a rare cause of graft failure in the first 10 year post-transplant period. Aggressive intervention to modify cardiovascular risk factors should improve patient and graft survival in diabetic kidney transplant recipients.
糖尿病患者的肾移植：明尼苏达大学的经验。
DOI：
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发表时间：
1992
期刊：
Kidney international. Supplement
影响因子：
--
作者：
Basadonna,G;Matas,AJ;Najarian,JS
通讯作者：
Najarian,JS
100 名 I 型糖尿病患者肾移植后的长期生存。
影响因子：
6.2
作者：
Najarian,JS;Kaufman,DB;Fryd,DS;McHugh,L;Mauer,SM;Ramsay,RC;Kennedy,WR;Navarro,X;Goetz,FC;Sutherland,DE
通讯作者：
Sutherland,DE
筛查冠状动脉疾病的糖尿病移植候选者：低风险亚组的识别。
影响因子：
19.6
作者：
Manske,CL;Thomas,W;Wang,Y;Wilson,RF
通讯作者：
Wilson,RF