在ABO不相容的移植后的临床结果:系统性审查和分析
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
概括
与ABO相容的移植相比,ABOi- rTx的早期死亡率和移植损失率更高. 然而,五年后的长期结果显示,这两种方法的存活率和器官功能均相当.
科学领域:
- 科和移植手术
- 免疫学和器官移植
背景情况:
- ABO不相容的移植 (ABOi-rTx) 是解决器官短缺的一个关键策略.
- 对ABOi- rTx和ABO- 兼容移植 (ABOc- rTx) 的早期和晚期结果进行比较分析是必要的.
研究的目的:
- 研究和比较ABOi-rTx与ABOc-rTx的结果.
- 在移植后的不同时间点分析患者和移植存活率的差异.
主要方法:
- 在2017年12月31日之前发表的观察性研究的系统审查和元分析.
- 包括的研究报告了ABOi- rTx与ABO兼容对照组的结果数据 (≥1年随访).
- 主要终点包括全因死亡率和1年,3年,5年和8年以上的移植存活率;元分析采用固定效应或随机效应模型.
主要成果:
- 分析了40项涉及65,063名患者的研究 (7,098名ABOi- rTx).
- 与ABOc- rTx相比,ABOi- rTx与1年,3年和5年死亡率显著上升以及死亡审查的移植存活率较低.
- 分别在5年和8年后,移植损失和患者存活率变得相当;没有发现出版偏差.
结论:
- 与ABOc-rTx相比,尽管有进展,但ABOi-rTx在3年内增加了早期死亡率和移植损失.
- 长期结果 (5年后) 显示了可比的生存率和器官功能.
- 对 ABOi-rTx 增加的风险 (感染,排斥,出血) 的认识对于患者护理和配对更换计划至关重要.
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