扩大标准的供者肾移植中长期临床疗效分析

Analysis of middle/long-term clinical efficacy of expanded criteria donor kidney transplantation

目的分析比较扩大标准的供者(ECD)与标准供者肾移植受者的中长期预后情况。方法回顾吉林大学第一医院2011年8月至2017年5月共506例肾移植临床资料,根据供者临床数据将相应受者分为ECD组和对照组,基于两组间基线资料初步比较结果进行1∶4倾向性评分匹配以最大程度消除选择偏差对结果的影响,最终选定ECD组(67例)、对照组(230例)进行分析研究。中位随访时间50个月,应用秩和检验等方法比较两组受者不同时间点估算的肾小球滤过率(eGFR)恢复情况、移植肾功能延迟、急性排斥反应、全因感染发生率以及受者/移植肾存活率等。结果ECD组受者在急性排斥反应、移植肾功能延迟、全因感染发生率方面与对照组差异无统计学意义(均P>0.05)。术后1周至术后4年,ECD组受者的eGFR均略低于对照组(P<0.05),第5年两组间差异无统计学意义(P=0.273)。受者/移植肾存活率两组间比较差异无统计学意义(P=0.143和P=0.076)。结论合理的供肾取舍标准和受者选择标准可以使ECD供肾的应用更安全、更科学、效率最大化。

Objective To compare the medium/long-term prognosis of kidney transplant recipients with expanded criteria donor(ECD)versus standard criteria donor(SCD).Methods From August 2011 to May 2017,a total of 506 cases underwent renal transplantation.Based upon baseline clinical data,they were divided into two groups of ECD(67 cases)and SCD(230 cases).And 1:4 propensity score matching was employed for maximizing the elimination of selection bias influence on the results by rank-sum test.Results There was no statistical difference existed between ECD and SCD donor kidney in acute rejection,delayed graft function and all-cause infection(all P>0.05).The value of eGFR of ECD donor kidney recipients was slightly lower than that of SCD group at Week 1 and Year 4 postoperatively(P<0.05).And there was no inter-group statistical significance in the fifth year(P=0.273).No significant inter-group difference existed in human/renal survival rate(P=0.143,P=0.076).Conclusions Appropriate selection criteria and recipient selection criteria can make the application of ECD donor kidney safer and more scientific so as to benefit more patients.