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首页> 外文期刊>Transplantation: Official Journal of the Transplantation Society >Prognosis after primary renal transplant failure and the beneficial effects of repeat transplantation: multivariate analyses from the United States Renal Data System.
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Prognosis after primary renal transplant failure and the beneficial effects of repeat transplantation: multivariate analyses from the United States Renal Data System.

机译：原发性肾移植失败后的预后以及重复移植的有益效果：来自美国肾脏数据系统的多变量分析。

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BACKGROUND: Survival of transplant recipients after primary renal allograft failure has not been well studied. METHODS: A cohort of 19,208 renal transplant recipients with primary allograft failure between 1985 and 1995 were followed from the date of allograft loss until death, repeat transplantation, or December 31, 1996. The mortality, wait-listing, and repeat transplantation rates were assessed. The mortality risks associated with repeat transplantation were estimated with a time-dependent survival model. RESULTS: In total, 34.5% (n=6,631) of patients died during follow-up. Of these deaths, 82.9% (n=5,498) occurred in patients not wait-listed for repeat transplantation, 11.9% (n=789) occurred in wait-listed patients, and 5.2% (n=344) occurred in second transplant recipients. Before repeat transplantation, the adjusted 5-year patient survival was 36%, 49%, and 65% for type I diabetes mellitus (DM), type II DM, and nondiabetic end-stage renal disease, respectively (P<0.001; DM vs. nondiabetics). The adjusted 5-year patient survival was lower in Caucasians (57%, P<0.001) compared with African-Americans (67%) and other races (64%). The 5-yr repeat transplantation rate was 29%, 15%, and 19%, whereas the median waiting time for a second transplant was 32, 90, and 81 months for Caucasians, African-Americans, and other races, respectively (P<0.0001 each). Repeat transplantation was associated with 45% and 23% reduction in 5-year mortality for type I DM and nondiabetic end-stage renal disease, respectively, when compared with their wait-listed dialysis counterparts with prior transplant failure. CONCLUSIONS: The loss of a primary renal allograft was associated with significant mortality, especially in recipients with type I DM. Repeat transplantation was associated with a substantial improvement in 5-year patient survival. Recipients with type I DM achieved the greatest proportional benefit from repeat transplantation.
机译：背景：原发性肾移植失败后移植受体的存活率尚未得到很好的研究。方法：从1985年至1995年间19208例原发同种异体移植失败的肾移植受者队列中，从同种异体移植之日起至死亡，再次移植或1996年12月31日为止。评估了死亡率，等待名单和重复移植率。用时间依赖性生存模型评估与重复移植相关的死亡风险。结果：总共有34.5％（n = 6,631）的患者在随访期间死亡。在这些死亡中，有82.9％（n = 5,498）发生在没有等待再次移植的患者中，有11.9％（n = 789）出现在了等待移植的患者中，有5.2％（n = 344）发生在第二次移植的患者中。在重复移植之前，I型糖尿病（DM），II型DM和非糖尿病终末期肾脏疾病的5年患者存活率调整后分别为36％，49％和65％（P <0.001; DM vs非糖尿病患者）。与非裔美国人（67％）和其他种族（64％）相比，高加索人（57.0％，P <0.001）的经调整的5年患者生存率较低。 5年重复移植率分别为29％，15％和19％，而高加索人，非裔美国人和其他种族的第二次移植的平均等待时间分别为32、90和81个月（P <每个0.0001）。与先前等待移植失败的透析患者相比，重复移植可使I型DM和非糖尿病终末期肾病的5年死亡率分别降低45％和23％。结论：原发性肾脏异体移植的丢失与死亡率显着相关，尤其是在I型DM患者中。重复移植与5年患者生存率的大幅提高有关。 I型DM的接受者从重复移植中获得了最大的比例收益。

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