Trends in the Timing of Pre-emptive Kidney Transplantation
Trends in the Timing of Pre-emptive Kidney Transplantation
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DOI：
10.1681/asn.2011010023
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发表时间：
2011-09-01
影响因子：
13.6
通讯作者：
Segev, Dorry L.
中科院分区：
文献类型：
--
作者：
Grams, Morgan E.;Massie, Allan B.;Segev, Dorry L.
预先肾移植被认为是最好的肾脏替代治疗，但没有指南指导其在CKD进展期间的时机。我们使用了1995-2009年间19，471名首次抢先肾移植受者的全国队列，以评估移植时机的模式和影响。随着时间的推移，抢先移植时的平均估计GFR（eGFR）显著增加，从1995年的9.2 ml/min/1.73m2增加到2009年的13.8 ml/min/1.73m2（P= 15 ml/min/1.73 m（2））表示优先移植受者的比例从1995年的9%增加到2009年的35%; eGFR >= 10的患者的趋势相似（30%至72%）。无论是在全队列还是在理论上可能受益于早期抢先移植的患者的亚组分析中，我们都没有发现移植时eGFR分层之间的患者生存率或死亡删失移植物生存率存在统计学显著差异。总之，在天然肾功能水平提高的情况下进行抢先性肾移植。早期移植似乎与患者或移植物存活无关，这表明早期先发制人的移植可能会使供体和受体面临过早手术的风险，并浪费受体的天然肾功能。
Pre-emptive kidney transplantation is considered the best available renal replacement therapy, but no guidelines exist to direct its timing during CKD progression. We used a national cohort of 19,471 first-time pre-emptive kidney transplant recipients between 1995-2009 to evaluate patterns and implications of transplant timing. Mean estimated GFR (eGFR) at the time of pre-emptive transplant increased significantly over time, from 9.2 ml/min/1.73m(2) in 1995 to 13.8 ml/min/1.73m(2) in 2009 (P= 15 ml/min/1.73m(2) represented an increasing proportion of pre-emptive transplant recipients, from 9% in 1995 to 35% in 2009; the trend for patients with eGFR >= 10 was similar (30% to 72%). We did not detect statistically significant differences in patient survival or death-censored graft survival between strata of eGFR at the time of transplant, either in the full cohort or in subgroup analyses of patients who might theoretically benefit from earlier pre-emptive transplantation. In summary, pre-emptive kidney transplantation is occurring at increasing levels of native kidney function. Earlier transplantation does not appear to associate with patient or graft survival, suggesting that earlier pre-emptive transplantation may subject donors and recipients to premature operative risk and waste the native kidney function of recipients.