Analyses of the short- and long-term graft survival after kidney transplantation in Europe between 1986 and 2015
Analyses of the short- and long-term graft survival after kidney transplantation in Europe between 1986 and 2015
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DOI：
10.1016/j.kint.2018.05.018
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发表时间：
2018-11-01
影响因子：
19.6
通讯作者：
Naesens, Maarten
中科院分区：
文献类型：
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作者：
Coemans, Maarten;Suesal, Caner;Naesens, Maarten
在供者和受者人口统计不断变化的背景下，移植肾存活率的演变仍然没有得到充分的研究。由于缺乏欧洲数据，我们进行了一项队列研究(1986-2015)，基于协作性移植研究，包括21个欧洲国家135家医院的108 787名脑死亡肾脏捐赠者。分析移植后肾功能衰竭的发生率。在1986年至1999年间，移植物存活率的改善在短期内比长期内更为显著：移植后一年、五年和十年的风险分别下降了%(95%可信区间，61%-66%)、53%(49%-57%)和45%(39%-50%)。从2000年到2015年，移植后一年、五年和十年的风险分别下降了22%(12-30%)、47%(36-56%)和(45-76%)。自2000年以来，移植后头五年移植物存活率的改善明显减少，而五年后的改善与之前相当。在2000-2015年期间，移植物存活率的长期改善大于短期。这些变化与供受者特征的变化无关，反映了过去几十年来全球肾移植管理的演变。不幸的是，在考虑了供者和受者特征的演变后，我们发现移植物存活率的短期改善自2000年以来有所下降，而长期改善在欧洲保持不变。因此，最近几年移植物短期存活率改善的减速表明，对创新的需求尚未得到满足。
The evolution of kidney allograft survival remains insufficiently studied in the context of the changing donor and recipient demographics. Since European data are lacking we performed a cohort study (1986-2015) that, based on the Collaborative Transplant Study, included 108 787 recipients of brain-death kidney donors in 135 hospitals across 21 European countries. We analyzed the hazard rate of kidney failure after transplantation. Between 1986 and 1999, improvement in graft survival was more pronounced in the short term than in the long term: one-, five-and ten-year hazard rates after transplantation declined 64% (95% confidence interval, 61%-66%), 53% (49%-57%) and 45% (39%-50%), respectively. Between 2000 and 2015, hazard rates at one, five and ten years post-transplant declined respectively 22% (12-30%), 47% (36-56%) and 64% (45-76%). Improvement in graft survival in the first five years post-transplant was significantly less since 2000, while improvement after five years was comparable to before. During the 2000-2015 period improvement of graft survival was greater in the long than in the short term. These changes were independent of changing donor and recipient characteristics, and reflect the evolution in global kidney transplant management over the past decades. Unfortunately, after accounting for the evolution of donor and recipient characteristics, we found that short-term improvement in graft survival decreased since 2000, while long-term improvement remained unchanged in Europe. Thus, deceleration of short-term graft survival improvement in more recent years illustrates an unmet need for innovation.