Comparison of Kidney Graft Function and Survival in an Emulated Trial With Living Donors and Brain-Dead Donors.

IF 2.7 3区医学 Q1 SURGERY

Transplant International Pub Date : 2024-08-29 DOI:10.3389/ti.2024.13208

Emilie Savoye,Gaëlle Santin,Camille Legeai,François Kerbaul,François Gaillard,Myriam Pastural

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引用次数: 0

Abstract

Living donation (LD) transplantation is the preferred treatment for kidney failure as compared to donation after brain death (DBD), but age may play a role. We compared the 1-year estimated glomerular filtration rate (eGFR) after kidney transplantation for recipients of LD and DBD stratified by recipient and donor age between 2015 and 2018 in a matched cohort. The strength of the association between donation type and 1-year eGFR differed by recipient age (P interaction < 0.0001). For LD recipients aged 40-54 years versus same-aged DBD recipients, the adjusted odds ratio (aOR) for eGFR ≥60 mL/min/1.73 m2 was 1.48 (95% CI: 1.16-1.90). For DBD recipients aged ≥ 60 years, the aOR was 0.18 (95% CI: 0.12-0.29) versus DBD recipients aged 40-54 years but was 0.91 (95% CI: 0.67-1.24) versus LD recipients aged ≥60 years. In the matched cohort, 4-year graft and patient survival differed by donor age and type. As compared with DBD grafts, LD grafts increased the proportion of recipients with 1-year eGFR ≥60 mL/min/1.73 m2. Recipients aged ≥60 years benefited most from LD transplantation, even if the donor was aged ≥60 years. For younger recipients, large age differences between donor and recipient could also be addressed with a paired exchange program.

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活体捐献者与脑死亡捐献者肾移植功能和存活率的模拟试验比较

与脑死亡后捐献（DBD）相比，活体捐献（LD）移植是肾衰竭的首选治疗方法，但年龄可能起一定作用。我们在一个匹配队列中比较了 2015 年至 2018 年间按受者和捐赠者年龄分层的 LD 和 DBD 肾移植受者术后 1 年估计肾小球滤过率（eGFR）。受者年龄不同，捐赠类型与 1 年 eGFR 之间的关联强度也不同（P 交互作用 < 0.0001）。对于 40-54 岁的 LD 受者与同年龄的 DBD 受者，eGFR ≥60 mL/min/1.73 m2 的调整赔率（aOR）为 1.48（95% CI：1.16-1.90）。对于年龄≥60 岁的 DBD 受试者，与 40-54 岁的 DBD 受试者相比，aOR 为 0.18（95% CI：0.12-0.29），但与年龄≥60 岁的 LD 受试者相比，aOR 为 0.91（95% CI：0.67-1.24）。在配对队列中，4 年移植物存活率和患者存活率因供体年龄和类型而异。与 DBD 移植物相比，LD 移植物增加了 1 年 eGFR ≥60 mL/min/1.73 m2 的受者比例。年龄≥60 岁的受者从 LD 移植中获益最多，即使供体的年龄也≥60 岁。对于年龄较小的受者，供体和受体之间的巨大年龄差异也可以通过配对交换计划来解决。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Transplant International 医学-外科

CiteScore

4.70

自引率

6.50%

发文量

211

审稿时长

3-8 weeks

期刊介绍： The aim of the journal is to serve as a forum for the exchange of scientific information in the form of original and high quality papers in the field of transplantation. Clinical and experimental studies, as well as editorials, letters to the editors, and, occasionally, reviews on the biology, physiology, and immunology of transplantation of tissues and organs, are published. Publishing time for the latter is approximately six months, provided major revisions are not needed. The journal is published in yearly volumes, each volume containing twelve issues. Papers submitted to the journal are subject to peer review.