在国家肾脏交换计划中，有利的活体肾移植结果：倾向评分匹配分析。

IF 8.5 1区医学 Q1 UROLOGY & NEPHROLOGY

Clinical Journal of the American Society of Nephrology Pub Date : 2025-03-01 Epub Date: 2025-01-29 DOI:10.2215/CJN.0000000611

Stijn C van de Laar, Annelies E de Weerd, Frederike J Bemelman, Mirza M Idu, Aiko P J de Vries, Ian P J Alwayn, Stefan P Berger, Robert A Pol, Arjan D van Zuilen, Raechel J Toorop, Luuk B Hilbrands, Paul P C Poyck, Maarten H L Christiaans, Jorinde H H van Laanen, Jacqueline van de Wetering, Hendrikus J A N Kimenai, Marlies E J Reinders, Robert J Porte, Frank J M F Dor, Robert C Minnee

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引用次数: 0

摘要

背景：kep（肾脏交换计划）促进了供体不相容患者的活体肾脏移植（LDKT），由于更高的致敏性和更长的透析周期，这些患者通常比非kep患者风险更高。我们对KEP和非KEP活体肾移植的移植结果和危险因素进行了比较分析。方法：纳入2004-2021年间在荷兰进行的所有LDKTs。主要结局指标为1年、5年和10年死亡审查后的移植物存活（DCGS）。次要结局指标为延迟移植物功能（DGF）、移植物功能、排异率和患者生存率。我们使用倾向评分匹配模型来解释基线上的差异。结果：在7536例ldkt中，694例（9%）通过KEP移植。KEP组10年移植物存活率为0.916 (95% CI: 0.894 ~ 0.939)，非KEP组为0.919 （0.912 ~ 0.926,p = 0.82）。我们观察到5年排斥反应（12% vs 7%）和5年患者生存率（KEP: 84%，非KEP: 90%）的显著差异，在倾向评分匹配后无显著性差异。移植存活率降低的重要危险因素包括供者年龄高、再移植、透析时间延长、面板反应性抗体较高以及肾病综合征作为终末期肾病的病因。结论：通过KEP移植为缺乏相容供者的患者提供了一种可行的替代方案，避免了特异性和侵入性的移植前后治疗。KEP与非KEP的生存率相似，建议优先考虑KEP LDKT，而不是已故供者肾移植、脱敏和透析。然而，临床医生在规划和管理移植前后护理时应考虑已确定的危险因素，以提高患者的预后。因此，我们主张在缺乏此类项目的地区广泛采用和建立KEP，同时发起和扩大国际合作。

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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Favorable Living Donor Kidney Transplantation Outcomes within a National Kidney Exchange Program: A Propensity Score-Matching Analysis.

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来源期刊

Clinical Journal of the American Society of Nephrology 医学-泌尿学与肾脏学

CiteScore

12.20

自引率

3.10%

发文量

514

审稿时长

3-6 weeks

期刊介绍： The Clinical Journal of the American Society of Nephrology strives to establish itself as the foremost authority in communicating and influencing advances in clinical nephrology by (1) swiftly and effectively disseminating pivotal developments in clinical and translational research in nephrology, encompassing innovations in research methods and care delivery; (2) providing context for these advances in relation to future research directions and patient care; and (3) becoming a key voice on issues with potential implications for the clinical practice of nephrology, particularly within the United States. Original manuscript topics cover a range of areas, including Acid/Base and Electrolyte Disorders, Acute Kidney Injury and ICU Nephrology, Chronic Kidney Disease, Clinical Nephrology, Cystic Kidney Disease, Diabetes and the Kidney, Genetics, Geriatric and Palliative Nephrology, Glomerular and Tubulointerstitial Diseases, Hypertension, Maintenance Dialysis, Mineral Metabolism, Nephrolithiasis, and Transplantation.