Earlier is not necessarily better in preemptive kidney transplantation

被引:36
|
作者
Akkina, S. K. [1 ]
Connaire, J. J. [2 ]
Snyder, J. J. [4 ]
Matas, A. J. [3 ]
Kasiske, B. L. [1 ,2 ]
机构
[1] Univ Minnesota, Med Ctr, Dept Med, Minneapolis, MN 55455 USA
[2] Univ Minnesota, Hennepin Cty Med Ctr, Minneapolis, MN 55415 USA
[3] Univ Minnesota, Med Ctr, Dept Surg, Minneapolis, MN 55455 USA
[4] Minneapolis Med Res Fdn Inc, Chron Dis Res Grp, Minneapolis, MN USA
基金
美国国家卫生研究院;
关键词
delayed graft function (DGF); glomerular filtration rate; graft function; graft survival; kidney transplantation; patient survival; preemptive;
D O I
10.1111/j.1600-6143.2008.02381.x
中图分类号
R61 [外科手术学];
学科分类号
摘要
While preemptive (before chronic dialysis) transplantation is associated with improved graft survival, it is unclear whether higher versus lower pretransplant kidney function is associated with even better graft survival after preemptive transplantation. We examined 671 first, preemptive, kidney-only transplantations at Hennepin County Medical Center and the University of Minnesota Medical Center 1984-2006. We estimated pretransplant glomerular filtration rate (eGFR, mL/min/1.73 m(2)) using the Modification of Diet in Renal Disease (MDRD) equation with Group 1: < 10.0 (7.3 +/- 1.7, N = 324), Group 2: 10.0-14.9 (12.0 +/- 1.4, N = 217) and Group 3: >= 15.0 (21.1 +/- 10.0, N = 130). The mean difference in eGFR for Group 1 versus 3 was 13.8 pretransplant, 16.3 on day 1 and 13.9 on day 2 posttransplant. By week 1 and year 1 posttransplant, the differences between Groups 1 and 3 reduced to 6.3 and 4.5 mL/min/1.73 m(2), respectively. The adjusted relative risk (RR; Cox analysis) for graft failure was not significantly lower with higher pretransplant eGFR (reference eGFR < 10.0); RR = 0.99 (95% confidence interval = 0.68-1.44, p = 0.9432) for eGFR 10.0-14.9; RR = 1.35 (0.89-2.05, p = 0.1588) for eGFR >= 15. Thus, early preemptive transplantation with higher eGFR does not necessarily improve graft survival after kidney transplantation, compared to preemptive transplantation with lower pretransplant eGFR.
引用
收藏
页码:2071 / 2076
页数:6
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