ABO不適合性腎臓移植後の臨床結果: 系統的レビューとメタ解析
Florian G Scurt1, Lara Ewert1, Peter R Mertens1
1Clinic of Nephrology and Hypertension, Diabetology and Endocrinology, Health Campus Immunology, Infectiology and Inflammation, Otto-von-Guericke-University Magdeburg, Magdeburg, Germany.
Lancet (London, England)
|April 23, 2019
まとめ
ABO互換性腎臓移植 (ABOi- rTx) は,ABO互換性腎臓移植 (ABOc- rTx) に比べて早期死亡率と移植喪失率が高くなります. しかし5年後の長期的な結果は 両方の方法の生存率と臓器機能が等しいことを示しています
科学分野:
- 腎臓 術 と 移植 術
- 免疫学と臓器移植
背景:
- ABO不適合性腎臓移植 (ABOi-rTx) は臓器不足に対処するための重要な戦略です.
- ABOi- rTxと ABO互換性腎臓移植 (ABOc- rTx) の早期と後期の結果の比較分析は不可欠である.
研究 の 目的:
- ABOi- rTx と ABOc- rTx の結果を調査し,比較する.
- 移植後の様々な時点での患者と移植物の生存の違いを分析する.
主な方法:
- 2017年12月31日までに発表された観察研究の体系的レビューとメタ解析.
- 含まれている研究では,ABOi- rTxに対するアウトカムデータ (≥1年フォローアップ) が報告され,ABO互換の対照群が対象でした.
- 主要エンドポイントは,全因死亡率と1,3,5,および>8年の移植生存率;メタ解析では固定効果またはランダム効果モデルを使用した.
主要な成果:
- 65, 063人の患者 (7, 098人のABOi- rTx) を含む40件の研究を分析した.
- ABOi- rTxは,ABOc- rTxと比較して,1年,3年,5年の死亡率と,死亡検閲による移植生存率が著しく高かった.
- 移植の損失と患者の生存率は,それぞれ5年および8年後に同等になった.
結論:
- 進歩にもかかわらず,ABOi- rTxは,ABOc- rTxと比較して3年以内に早期死亡率と移植の損失を増加させています.
- 長期的アウトカム (5年後) は,比較可能な生存率と臓器機能を示しています.
- ABOi- rTxにおけるリスクの増加 (感染,拒絶,出血) の認識は,患者ケアとペアリングされた腎臓交換プログラムにとって不可欠です.
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