死んだドナーの特徴と腎臓移植の生存効果
Robert M Merion1, Valarie B Ashby, Robert A Wolfe
1Department of Surgery, University of Michigan Health System, Ann Arbor 48109-0331, USA. merionb@umich.edu
JAMA
|December 8, 2005
まとめ
拡張基準ドナー (ECD) 腎臓移植は,より高い初期移植不全リスクにもかかわらず,患者の生存率を向上させます. これらの移植は,長い待ち時間のある地域では40歳以上の候補者,短い待ち時間のある地域では糖尿病患者のために推奨されます.
科学分野:
- ネフロロジーはネフロロジーを用います.
- 移植免疫学について
- 公衆衛生は公衆衛生である.
背景:
- 拡張基準のドナー (ECD) 腎臓移植は,標準の死亡ドナー移植と比較して,移植不全のリスクが70%高い.
- しかし,ECD移植は患者の全生存率を向上させ,移植の結果を潜在的に許容可能なトレードオフにすることができます.
研究 の 目的:
- ECD腎臓移植を受けた患者と標準治療 (非ECD移植または透析) を受けた対照群の死亡率を比較する.
主な方法:
- リトロスペクティブコホート研究では,米国国立レジストリから得られたデータを分析し,1995年から2002年にかけて109,127人の透析患者および腎臓の待合者リストに登録された患者を含む.
- フォローアップは2004年7月まで延長され,時間依存のコックス回帰モデルを使用して死亡リスクが推定されました.
主要な成果:
- 長期 (3年) の相対的な死亡リスクは,ECD腎臓受容者にとって17%低かった (RR,0.83;95%CI,0.77-0.90).
- 40歳以上の患者,両方の性別,非ヒスパニック系,すべての人種,不敏感な患者,糖尿病または高血圧の患者で,著しいECD生存効果が観察されました.
- 長い待ち時間 (>1350日) を有する臓器調達機関 (OPO) では,ECD受給者の死亡リスクが27%低かった (RR,0.73;95%CI,0.64-0.83).
結論:
- ECD腎臓移植は,主に,長い待ち時間を持つOPOの40歳以上の候補者に提供されるべきです.
- 待ち時間が短いOPOでは,ECD移植の候補者は,生存上の利点が主に糖尿病患者に見られることを知らされるべきです.
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