Patient and Kidney Allograft Survival with National Kidney Paired Donation
Patient and Kidney Allograft Survival with National Kidney Paired Donation
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DOI：
10.2215/cjn.06660619
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发表时间：
2020-02-07
影响因子：
9.8
通讯作者：
Flechner, Stuart M.
中科院分区：
文献类型：
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作者：
Leeser, David B.;Thomas, Alvin G.;Flechner, Stuart M.
背景和目标在美国，肾脏配对捐赠网络每年促进肾移植的比例不断增加，但配对捐赠和其他活体肾移植受者之间超过5年的移植结果差异尚未得到很好的描述。设计、设置、参与者和测量使用登记相关数据，我们将国家肾脏登记处（n = 2363）接受者与对照肾移植接受者（n = 54,497）进行比较（2008年2月至2017年12月）。我们使用治疗加权 Cox 回归的逆概率估计了死亡审查的移植失败和死亡率的风险。简约模型根据受者因素（年龄、性别、黑人、种族、体重指数≤30 kg/m(2)、糖尿病、既往移植、先发性移植、公共保险、丙型肝炎、eGFR、抗体消耗诱导治疗、移植年份）、供体因素（年龄、性别、西班牙裔、体重指数≤30 kg/m(2)）和移植因素（零 HLA 不匹配）进行调整。女性、黑人、年龄较大、有公共保险、群体反应性抗体>80%、透析时间更长、并且是以前的移植接受者。国家肾脏登记接受者的随访时间中位数为 3.7 年（四分位数范围，2.1?5.6；最长 10.9 年）。随访期间，与对照组相比，国家肾脏登记受者的移植失败率（5% 对比 6%；对数秩 P=0.2）和死亡率（9% 对比 10%；对数秩 P=0.4）发生率相似。调整供体、受体和移植因素后，国家肾脏登记处和对照受者之间的移植失败（调整后风险比，0.95；95% 置信区间，0.77 至 1.18；P=0.6）或死亡率（调整后风险比，0.86；95% 置信区间，0.70 至 1.07；P=0.2）没有可检测到的差异。 结论与对照活体肾移植受者相比，国有化配对捐赠可产生相同的结果。
Background and objectivesIn the United States, kidney paired donation networks have facilitated an increasing proportion of kidney transplants annually, but transplant outcome differences beyond 5 years between paired donation and other living donor kidney transplant recipients have not been well described.Design, setting, participants, & measurementsUsing registry-linked data, we compared National Kidney Registry (n=2363) recipients to control kidney transplant recipients (n=54,497) (February 2008 to December 2017). We estimated the risk of death-censored graft failure and mortality using inverse probability of treatment weighted Cox regression. The parsimonious model adjusted for recipient factors (age, sex, black, race, body mass index ?30 kg/m(2), diabetes, previous transplant, preemptive transplant, public insurance, hepatitis C, eGFR, antibody depleting induction therapy, year of transplant), donor factors (age, sex, Hispanic ethnicity, body mass index ?30 kg/m(2)), and transplant factors (zero HLA mismatch).ResultsNational Kidney Registry recipients were more likely to be women, black, older, on public insurance, have panel reactive antibodies >80%, spend longer on dialysis, and be previous transplant recipients. National Kidney Registry recipients were followed for a median 3.7 years (interquartile range, 2.1?5.6; maximum 10.9 years). National Kidney Registry recipients had similar graft failure (5% versus 6%; log-rank P=0.2) and mortality (9% versus 10%; log-rank P=0.4) incidence compared with controls during follow-up. After adjustment for donor, recipient, and transplant factors, there no detectable difference in graft failure (adjusted hazard ratio, 0.95; 95% confidence interval, 0.77 to 1.18; P=0.6) or mortality (adjusted hazard ratio, 0.86; 95% confidence interval, 0.70 to 1.07; P=0.2) between National Kidney Registry and control recipients.ConclusionsEven after transplanting patients with greater risk factors for worse post-transplant outcomes, nationalized paired donation results in equivalent outcomes when compared with control living donor kidney transplant recipients.