Post-listing survival for highly sensitised patients on the UK kidney transplant waiting list: a matched cohort analysis
Post-listing survival for highly sensitised patients on the UK kidney transplant waiting list: a matched cohort analysis
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DOI：
10.1016/s0140-6736(16)31595-1
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发表时间：
2017-02-18
期刊：
影响因子：
168.9
通讯作者：
Mamode, Nizam
中科院分区：
文献类型：
--
作者：
Manook, Miriam;Koeser, Leonardo;Mamode, Nizam
背景：在英国，超过40%的等待肾脏移植的患者对人类白细胞抗原（HLA）抗体敏感。这类患者的中位移植时间是不敏感患者的两倍，约为74个月。去除抗体进行hla不相容（HLAi）活体供体移植被认为是高风险的，尽管患者生存数据有限。我们比较了选择HLAi肾移植的患者与同样敏感的等待相容器官的患者的生存率。方法从英国成人肾移植等待名单中选择2007年1月1日至2013年12月31日接受肾移植的交叉配型阳性活体供体HLAi肾移植受者，随访至2014年12月31日（研究结束）。这些患者以1:4的比例与在此期间接受已故供者移植的相似敏感患者进行匹配。数据在移植时（仅列出）和研究期结束时（列出或移植）都进行了审查。我们使用Kaplan-Meier曲线来比较HLAi和匹配队列之间的患者生存率。在25518例患者中，213例（1%）在研究期间接受了HLAi移植。确定了852例匹配对照，其中41% （95% CI 32-50）在匹配后58个月未进行移植。我们注意到，与单列组（log rank p=0.446）或单列或移植组（log rank p=0.984）相比，hai组患者的生存率无差异。解释：在英国，接受HLAi的敏感患者的生存率与那些等待相容器官的透析患者相当，其中许多人不太可能进行移植。与北美多中心队列研究的类似患者相比，选择直接HLAi移植对生存没有不利影响，但没有提供生存益处。
Background More than 40% of patients awaiting a kidney transplant in the UK are sensitised with human leucocyte antigen (HLA) antibodies. Median time to transplantation for such patients is double that of unsensitised patients at about 74 months. Removing antibody to perform an HLA-incompatible (HLAi) living donor transplantation is perceived to be high risk, although patient survival data are limited. We compared survival of patients opting for an HLAi kidney transplant with that of similarly sensitised patients awaiting a compatible organ.Methods From the UK adult kidney transplant waiting list, we selected crossmatch positive living donor HLAi kidney transplant recipients who received their transplant between Jan 1, 2007, and Dec 31, 2013, and were followed up to Dec 31, 2014 (end of study). These patients were matched in a 1:4 ratio with similarly sensitised patients cases listed for a deceased-donor transplant during that period. Data were censored both at the time of transplantation (listed only), and at the end of the study period (listed or transplant). We used Kaplan-Meier curves to compare patient survival between HLAi and the matched cohort.Findings Of 25 518 patient listings, 213 (1%) underwent HLAi transplantation during the study period. 852 matched controls were identified, of whom 41% (95% CI 32-50) remained without a transplant at 58 months after matching. We noted no difference in survival between patients who were in the HLAi group compared with the listed only group (log rank p=0.446), or listed or transplant group (log rank p=0.984).Interpretation Survival of sensitised patients undergoing HLAi in the UK is comparable with those on dialysis awaiting a compatible organ, many of whom are unlikely to be have a transplant. Choosing a direct HLAi transplant has no detrimental effect on survival, but offers no survival benefit, by contrast with similar patients studied in a North American multicentre cohort.