慢性移植物失功的器官特异性：基于OPTN数据的分析

Organ Specificity of Chronic Graft Dysfunction: An Analysis Based on Data of OPTN

目的寻找不同移植器官发生慢性移植物失功(chronic graft dysfunction,CGD)的变化规律,证实不同器官CGD发生率不同与移植器官种类有关,即CGD的器官特异性。方法网上获取OPTN/SRTR(organ procurement and transplantation network/scientic registry of transplant recipient)2006年报,收集近10年全球29.6万余例各种实体器官各时点移植物存活率。根据总表统计数据用图示法寻找移植物存活率在各种移植实体器官的变化趋势;根据分表统计数据,按不同年龄组、性别和人种作图,进一步观察趋势。以不同时段移植物存活率为变量,分层聚类分析,将各种实体移植器官分成两类。确定低存活标准,将各种实体移植器官不同时段移植物存活率与之比较,用森林图法直观展示高低不同的两类。结果各时段边缘供肾、单独胰腺移植、肾移植后胰腺移植、小肠移植、尸肺移植和心肺移植的移植物存活率在不同年龄段(18～34、35～49、50～64岁)、性别和人种均较低。以各种实体器官移植1991～1995年和1996～2000年两个时段的1年、3年和5年移植器官近期存活率(GSR)为变量聚类分析,上述低存活器官聚为一类,与低存活率相关。以边缘供肾GSR为标准,上述低存活器官两个时段3月、1年、3年和5年GSR均比边缘供肾低[3月GSR,OR0.26～0.92;95%CI(0.20,0.35)～(0.61,1.39);1年GSR,OR0.30～0.87,95%CI(0.23,0.37)～(0.78,0.97);3年GSR5年GSR,OR0.12～0.87;95%CI(0.09,0.71)～(0.75,1.0)]。结论CGD在不同器官的变化具有规律性。各种实体移植器官GSR可聚为高低存活两类,低GSR器官为边缘供肾、单独胰腺移植、肾移植后胰腺移植、小肠移植、尸肺移植和心肺移植,表现为高发早发CGD。

Objective Chronic graft dysfunction （CGD） has become the major factor that influences the long-term survival of grafts. It is unclear whether the different incidence of CGD has organ specificity. Methods We collected the graft survival rates （GSRs） of solid organ transplantations from the OPTN/SRTR （organ procurement and transplantation network/scientific registry of transplant recipient）. The solid organ transplantations were classified according to the cluster analyses of GSRs during two time periods. We defined the standard of lower survival rate and compared it to the 3-month GSRs （3mGSRs）, 1-year GSRs （1y GSRs）, 3y GSRs, and 5y GSRs of various solid organ transplantations. Results Deceased donor ECD kidney （DD-ECDK）, pancreas transplantation alone （PTA）, pancreas after kidney transplantation （PAK）, Intestine （In）, deceased donor lung （DD-Lu）, and heart-lung （H-Lu） were classified into a category which was associated with lower graft survival rates based on the variables of GSRs during the time periods of 1991-1995 and 1996-2000. Compared with those of DD-ECDK, the lowest in the three types of kidney transplantation, the GSRs during the two time periods of the above organ transplantations of lower graft survival were lower [3mGSRs： OR 0.26-0.92, 95%CI （0.20, 0.35）-（0.61,1.39）; ly GSRs ： OR 0.30-0.87, 95%CI （0.23,0.37）-（0.78,0.97）; 3y GSRs： OR 0.39-0.77, 95%CI （0.30,0.51）-（0.61,0.98）; 5y GSRs： OR 0.12-0.87, 95%CI （0.09,0.71）- （0.75,1.0）]. Conclusion The CGD had organ specificity. The grafts of DD-ECDK, PTA, PAK, In, DD-Lu, and H-Lu were identified as the organs with earlier onsets and higher incidence of CGD.