肝移植后肾脏的配对分析：是否将肾脏分配给适当的患者以最大限度地提高其存活率？
Kidney After Liver Transplantation Matched-pair Analysis: Are Kidneys Allocated to Appropriate Patients to Maximize Their Survival?
机构信息
Division of Transplantation, Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, WI.
Department of Surgery, New York Medical College at Metropolitan Hospital Center, New York, NY.
出版信息
Transplantation. 2020 Apr;104(4):804-812. doi: 10.1097/TP.0000000000002870.
BACKGROUND
Kidney after liver transplantation (KALT) is the best therapeutic option for patients with end-stage renal disease after orthotopic liver transplantation (OLT). New allocation policies prioritize kidneys to patients in renal failure within the first year following OLT. There is little data on how kidney quality, measured by kidney donor profile index (KDPI), impacts KALT survival outcomes.
METHODS
The United Network for Organ Sharing database was queried for adult KALT recipients from 1988 to 2015 and compared to their paired kidney transplant alone (KTA) recipients. Seven hundred forty-five pairs were stratified into 3 KDPI subgroups and compared patient survival, graft survival, and death-censored graft survival among matched-paired recipients.
RESULTS
Overall, KTA recipients had superior patient and graft survival compared with the KALT group. KTA patient survival was superior for all 3 KDPI subgroups analysis. KTA graft survival was superior compared with KALT recipients of KDPI 21%-85% kidneys. Inferior graft half-life was observed in KALT versus KTA recipients with KDPI 21%-85% and >85%.
CONCLUSIONS
From a utilitarian perspective, it is important that kidneys are allocated to recipients that are able to maximize their benefit from the full life of the organ. In KTA recipients, graft quality correlates directly to graft survival. However, in KALT patients receiving the matched-pair kidneys of the KTA recipients, patient mortality, rather than kidney quality, dictates graft survival significantly. As allocation practices continue developing, utilization of expanded criteria kidneys that better match anticipated patient and graft survival should be strongly considered to maximize the benefits of limited resources for the greatest number of patients.
背景
肝移植后肾脏（KALT）是肝移植（OLT）后终末期肾病患者的最佳治疗选择。新的分配政策将肾脏优先分配给 OLT 后一年内肾衰竭的患者。关于肾脏质量（通过肾脏供体概况指数（KDPI）衡量）如何影响 KALT 生存结果的数据很少。
方法
从 1988 年到 2015 年，对美国器官共享网络数据库中的成人 KALT 受者进行了查询，并将其与配对的单独肾脏移植（KTA）受者进行了比较。将 745 对患者分为 3 个 KDPI 亚组，并比较匹配配对受者的患者生存率、移植物生存率和死亡风险校正移植物生存率。
结果
总体而言，KTA 受者的患者和移植物生存率均优于 KALT 组。在所有 3 个 KDPI 亚组分析中，KTA 患者生存率均优于 KALT 组。与 KALT 受者相比，KDPI 为 21%-85%的 KTA 移植物生存率更高。与 KALT 受者相比，KDPI 为 21%-85%和>85%的 KALT 受者的移植物半衰期更短。
结论
从功利主义的角度来看，将肾脏分配给能够最大限度地从器官的全部寿命中受益的受者非常重要。在 KTA 受者中，移植物质量与移植物生存率直接相关。然而，在 KALT 患者中，接受 KTA 受者的配对肾脏的患者死亡率而不是肾脏质量，显著影响移植物生存率。随着分配实践的不断发展，应强烈考虑利用更好地匹配预期患者和移植物生存率的扩展标准肾脏，以最大限度地提高有限资源的效益，为更多患者服务。
Zotero 插件