Long-term survival in renal transplant recipients with graft function
Long-term survival in renal transplant recipients with graft function
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DOI：
10.1046/j.1523-1755.2000.00816.x
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发表时间：
2000-01-01
影响因子：
19.6
通讯作者：
Port, FK
中科院分区：
文献类型：
--
作者：
Ojo, AO;Hanson, JA;Port, FK
背景 移植物功能死亡（DWGF）是移植物丧失的常见原因。尚未在最近的一组肾移植受者中研究 DWGF 的风险和决定因素。我们对 1988 年至 1997 年间接受移植的美国终末期肾病 (ESRD) 患者进行了基于人群的生存分析。方法。注册数据用于评估 86,502 名成人（大于或等于 18 岁）肾移植受者的长期患者生存率和 DWGF 的特定原因风险。结果。在 18,482 例死亡中，38% (N = 7040) 是因移植功能所致死亡。这占所有移植物损失的 42.5%。具有移植功能的患者 1 年、5 年和 10 年生存率分别为 97%、91% 和 86%。 1988 年至 1997 年间，DWGF 的风险下降了 67%（RR = 0.33，P < 0.001）。调整后的 DWGF 死亡率分别为每 1000 人年 4.6、0.8、2.2 和 1.4 例心血管疾病、中风、感染和恶性肿瘤死亡。一般人群的自杀率为每 10 万人年 15.7 例和 9.0 例（P < 0.001）。在多变量分析中，以下因素可独立且显着地预测 DWGF：白人受者、移植时年龄、高血压或糖尿病引起的 ESRD、移植前透析时间、移植功能延迟、急性排斥反应、面板反应性抗体 >30%、非裔美国人供体种族、年龄 >45 岁以及供体因脑血管病导致的死亡 疾病。结论。具有移植功能的患者具有较高的长期生存率。尽管 DWGF 是移植物丢失的主要原因，但自 1990 年以来风险已大幅下降。据报道，心血管疾病是 DWGF 的主要原因。其他原因因移植后时间段而异。对动脉粥样硬化危险因素的关注可能是进一步提高成功肾移植患者寿命的最重要挑战。
Background Death with graft function (DWGF) is a common cause of graft loss. The risks and determinants of DWGF have not been studied in a recent cohort of renal transplant recipients. We performed a population-based survival analysis of U.S. patients with end-stage renal disease (ESRD) transplanted between 1988 and 1997.Methods. Registry data were used to evaluate long-term patient survival and cause-specific risks of DWGF in 86,502 adult (greater than or equal to 18 years) renal transplant recipients.Results. Out of 18,482 deaths, 38% (N = 7040) were deaths with graft function. This accounts for 42.5% of all graft loss. Patient survival with graft function was 97, 91, and 86% at 1, 5, and 10 years, respectively. The risk of DWGF decreased by 67% (RR = 0.33, P < 0.001) between 1988 and 1997. The adjusted rate of DWGF was 4.6, 0.8, 2.2, and 1.4 deaths per 1000 person-years for cardiovascular disease, stroke, infections, and malignancy, respectively. The suicide rate was 15.7 versus 9.0 deaths per 100,000 person-years in the general population (P < 0.001). In multivariate analysis, the following factors were independently and significantly predictive of DWGF: white recipient, age at transplantation, ESRD caused by hypertension or diabetes mellitus, length of pretransplant dialysis, delayed graft function, acute rejection, panel reactive antibody >30%, African American donor race, age >45 years, and donor death caused by cerebrovascular disease.Conclusions. Patients with graft function have a high longterm survival. Although DWGF is a major cause of graft loss, the risk has declined substantially since 1990. Cardiovascular disease was the predominant reported cause of DWGF. Other causes vary by post-transplant time period. Attention to atherosclerotic risk factors may be the most important challenge to further improve the longevity of patients with successful renal transplants.