与肾移植长期存活相关的因素：UNOS数据库的当代分析。

IF 0.8 4区医学 Q4 IMMUNOLOGY

Transplantation proceedings Pub Date : 2025-01-31 DOI:10.1016/j.transproceed.2025.01.006

Muhammad Hasnain Mankani , Omar Mahmud , Muhammad Saad Hafeez , Muhammad Abdullah Javed , Muhammad Abdullah Arain , Muneeb Ul-Haq , Abbas A. Rana

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引用次数: 0

摘要

背景：各种临床病理指标，如1年血清肌酐（Cr），已被用来预测移植后同种异体肾移植的预后。然而，缺乏对其与移植物长期存活关系的当代分析。本研究旨在分析现代移植患者预后因素与异体肾移植生存相关的最新数据。方法：对UNOS数据库（2008-2020）中的成人肾移植受者进行识别。活体和死亡供体异体移植物分别进行分析，并按1年血清Cr水平进行分层：≤1.0、1.0 ~ 1.5、1.5 ~ 2.0和>2.0 mg/dL。时间-事件分析以长期死亡审查的移植物存活为主要结果。此外，确定了与1年血清Cr升高和长期同种异体移植失败相关的因素。结果：纳入174,547例患者。10年生存率随着1年肌酐的升高而下降，并且在两种活体供体(Cr≤1.0 mg/dL：参考；Cr 1.0 ~ 1.5 mg/dL aHR = 1.77 [1.59 ~ 1.96]；Cr 1.5 ~ 2.0 mg/dL aHR = 3.24 [2.89 ~ 3.64]；Cr≤1.0 mg/dL aHR = 9.78, [8.64-11.07], P < 0.01)和死亡同种异体供体移植(Cr≤1.0 mg/dL：参考；Cr 1.0 ~ 1.5 mg/dL aHR = 1.74 [1.63 ~ 1.86]；Cr 1.5 ~ 2.0 mg/dL aHR = 3.06 [2.84 ~ 3.30]；Cr 2.0 mg/dL aHR = 8.51, [7.89 ~ 9.18], P < 0.01)。结论：这些结果表征了1年血清肌酐水平和其他临床病理因素与移植肾长期存活之间的关系。我们在当代患者队列中展示了预后因素根据移植失败风险对患者进行分层的能力，这代表了当前的实践和结果。

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Factors Associated With Long-term Kidney Allograft Survival: A Contemporary Analysis of the UNOS Database

Background

Various clinicopathologic markers, such as 1-year serum creatinine (Cr), have been used to prognosticate kidney allografts after transplantation. However, a contemporary analysis of their relationship with long-term graft survival is lacking. This study aimed to analyze recent data on the association of prognostic factors with kidney allograft survival in patients who underwent transplantation in the modern era.

Methods

Adult kidney-transplant recipients in the UNOS database (2008-2020) were identified. Living and deceased donor allografts were analyzed separately and stratified by 1-year serum Cr level: ≤1.0, 1.0 to 1.5, 1.5 to 2.0, and >2.0 mg/dL. Time-to-event analysis was performed with long-term death-censored graft survival as the primary outcome. In addition, factors associated with raised 1-year serum Cr and with long-term allograft failure were identified.

Results

174,547 patients were included. Ten-year survival decreased with increasing 1-year creatinine, and these trends persisted on adjusted analysis for both living donor (Cr ≤ 1.0 mg/dL: reference; Cr 1.0-1.5 mg/dL aHR = 1.77 [1.59-1.96]; Cr 1.5-2.0 mg/dL aHR = 3.24 [2.89-3.64] and; Cr > 2.0 mg/dL aHR = 9.78, [8.64-11.07], P < .01) as well as deceased donor allografts (Cr ≤ 1.0 mg/dL: reference; Cr 1.0-1.5 mg/dL aHR = 1.74 [1.63-1.86]; Cr 1.5-2.0 mg/dL aHR = 3.06 [2.84-3.30] and; Cr > 2.0 mg/dL aHR = 8.51, [7.89-9.18], P < .01).

Conclusion

These results characterize the association between 1-year serum creatinine levels and other clinicopathologic factors with long-term kidney allograft survival. We demonstrate the ability of prognostic factors to stratify patients by risk of graft failure in a contemporary patient cohort that is representative of current practice and outcomes.

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来源期刊

Transplantation proceedings 医学-免疫学

CiteScore

1.70

自引率

0.00%

发文量

502

审稿时长

60 days

期刊介绍： Transplantation Proceedings publishes several different categories of manuscripts, all of which undergo extensive peer review by recognized authorities in the field prior to their acceptance for publication. The first type of manuscripts consists of sets of papers providing an in-depth expression of the current state of the art in various rapidly developing components of world transplantation biology and medicine. These manuscripts emanate from congresses of the affiliated transplantation societies, from Symposia sponsored by the Societies, as well as special Conferences and Workshops covering related topics. Transplantation Proceedings also publishes several special sections including publication of Clinical Transplantation Proceedings, being rapid original contributions of preclinical and clinical experiences. These manuscripts undergo review by members of the Editorial Board. Original basic or clinical science articles, clinical trials and case studies can be submitted to the journal?s open access companion title Transplantation Reports.