出生顺序对同胞兄弟姐妹间活体肾移植预后的影响

The role of birth order in outcomes of renal transplantation from siblings

目的探讨同胞兄弟姐妹间活体肾移植时，供、受者的出生顺序对肾移植预后产生的影响。方法回顾性分析2006年1月到2013年7月227例同胞兄弟姐妹间肾移植的临床资料。根据供、受者的出生顺序，将受者分为两组：（1）长供幼组：104例，供者均为受者的同胞哥哥或姐姐；（2）幼供长组：123例，供者均为受者的同胞弟弟或妹妹。结果随访期间，有4例受者发生移植肾功能丧失，2例受者死亡。受者和移植肾术后5年总体存活率分别为98％和95％。在校正人口统计学方面的混杂因素的影响后，与长供幼组相比，幼供长组受者的死亡未校正的移植肾功能丧失的风险更高（HR=2．77，95％可信区间为0．23-33．00），但两组受者间的差异无统计学意义（P=0．42）；幼供长组受者的死亡校正移植肾功能丧失的风险更高（HR=10．79，95％可信区间为0．30-389．43），但两组受者间的差异无统计学意义（P〈0．05）。大部分受者首次排斥反应发生在术后2个月内，术后3年内未发生排斥反应的受者比例为86％。同胞活体肾移植供、受者的出生顺序对肾移植排斥反应无明显影响（HR=1．266，95％可信区间为0．391～4．103，P=0．694）。结论在同胞兄弟姐妹间活体肾移植中，供、受者的出生顺序可能并不影响肾移植的临床结局。

Objective To investigate the effect of birth order on outcomes of renal transplantation from siblings. Method We conducted a retrospective study to examine the immune effect exerted by hirth order in kidney transplantation between siblings. 227 kidney transplants were included and we stratified the cohort by birth order, old to young parings （group A, 104 pairs） and young to old pairings （group B, 123 pairs）, using old to young parings as reference group. Result During the follow-up period, 4 recipients suffered graft failure and 2 died. The survival rate of recipients and grafts was 98% and 95%, respectively. After adjusting the effect of confounding factors in demography, young to old pairings were found at a higher risk of developing death uncensored graft failure （Hazards ratio, HR = 2. 77, 95% CI： 0. 23, 33. 00）, which was not significantly different from group A （P = 0. 42）. And group B had a higher risk of developing death censored graft failure （HR = 10. 79, 95% CI： 0. 30-3B9. 43）, with no statistically significant difference （P〉0. 05）. Most rejections occurred in two months after transplantation, and the rejection-free rate in 3 years post-transplantation was 86%. Similarly, no significant difference was detected between the two groups in terms of death censored graft failure, and no benefit of birth order was found in rejection protection （HR ： 1. 266, 95% CI.. 0. 391, 4. 103, P = 0. 694）. Conclusion Birth order may not be taken into consideration in kidney transplantation between siblings.