Survival Benefit of Primary Deceased Donor Transplantation With High-KDPI Kidneys
Survival Benefit of Primary Deceased Donor Transplantation With High-KDPI Kidneys
复制标题
DOI：
10.1111/ajt.12830
复制
发表时间：
2014-10-01
影响因子：
8.8
通讯作者：
Segev, D. L.
中科院分区：
文献类型：
--
作者：
Massie, A. B.;Luo, X.;Segev, D. L.
肾脏捐赠者概况指数 (KDPI) 已被引入作为评估已故捐赠者肾脏报价的辅助手段，但高 KDPI 肾移植 (KT) 与临床替代方案（在收到较低 KDPI 肾脏之前仍在等待名单上）的相对益处仍然未知。使用时间依赖性 Cox 回归，我们评估了首次成人注册者中与高 KDPI KT（KDPI 71-80、81-90 或 91-100）相关的死亡风险与保守的较低 KDPI 方法（在收到 KDPI 0-70、0-80 或 0-90 的 KT 之前保持在候补名单上）的相关死亡风险，并根据候选者特征进行调整。高 KDPI KT 与短期死亡风险增加但长期死亡风险降低相关。 KDPI 71-80 KT、KDPI 81-90 KT 和 KDPI 91-100 KT 的接受者分别在 KT 后 7.7、18.0 和 19.8 个月达到累积生存盈亏平衡点，并在此后获得生存获益。所有三个高 KDPI 组的 5 年累积生存率均优于保守方法（p50 年，中心患者的中位等待时间为 33 个月）。高 KDPI KT 的接受者可以享受更好的长期生存；高 KDPI 评分并不自动构成拒绝已故供体肾脏的理由。
The Kidney Donor Profile Index (KDPI) has been introduced as an aid to evaluating deceased donor kidney offers, but the relative benefit of high-KDPI kidney transplantation (KT) versus the clinical alternative (remaining on the waitlist until receipt of a lower KDPI kidney) remains unknown. Using time-dependent Cox regression, we evaluated the mortality risk associated with high-KDPI KT (KDPI 71-80, 81-90 or 91-100) versus a conservative, lower KDPI approach (remain on waitlist until receipt of KT with KDPI 0-70, 0-80 or 0-90) in first-time adult registrants, adjusting for candidate characteristics. High-KDPI KT was associated with increased short-term but decreased long-term mortality risk. Recipients of KDPI 71-80 KT, KDPI 81-90 KT and KDPI 91-100 KT reached a break-even point of cumulative survival at 7.7, 18.0 and 19.8 months post-KT, respectively, and had a survival benefit thereafter. Cumulative survival at 5 years was better in all three high-KDPI groups than the conservative approach (p50 years and patients at centers with median wait time 33 months. Recipients of high-KDPI KT can enjoy better long-term survival; a high-KDPI score does not automatically constitute a reason to reject a deceased donor kidney.