Experience from an active preemptive kidney transplantation program--809 cases revisited
| Autor: | Karsten Midtvedt, Bartlomiej J Witczak, Hallvard Holdaas, Trond Jenssen, Anna Varberg Reisæter, Torbjørn Leivestad, Pål-Dag Line, Anders Hartmann, Jan Bitter |
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| Rok vydání: | 2009 |
| Předmět: |
Adult
Male Risk medicine.medical_specialty Time Factors Population Nephropathy Cohort Studies HLA Antigens Internal medicine Diabetes mellitus medicine Living Donors Prevalence Humans education Kidney transplantation Proportional Hazards Models Transplantation education.field_of_study business.industry Proportional hazards model Hazard ratio Graft Survival Panel reactive antibody Middle Aged medicine.disease Kidney Transplantation Surgery Kidney Failure Chronic Female business Cohort study |
| Zdroj: | Transplantation. 88(5) |
| ISSN: | 1534-6080 |
| Popis: | Preemptive kidney transplantation (PKT) is increasingly acknowledged. We wanted to investigate the results of an active PKT policy in an unselected end-stage renal disease population with high prevalence of PKT.From 1989 to 2007, 3400 first kidney transplantations were performed in which 809 were PKTs (24%). PKT patients were 7.4 years younger (P0.001), had more live donors (LD; 64% vs. 35%, P0.001), and fewer were panel reactive human leukocyte antigen antibody positive (2% vs. 6%, P0.001).In the Cox regression analyses of patient mortality, uncensored and death-censored graft failures, all potential risk factors tested were statistically significant, except for recipient sex (i.e., recipient and donor age, PKT, deceased donor [DD], diabetes nephropathy, human leukocyte antigen-DR mismatch, and panel reactive antibody positivity). For patient mortality, PKT and DD had a hazard ratio (HR) of 0.75 (P=0.001) and 1.38 (P0.001), respectively. The results were similar for uncensored and death-censored graft failures. Risk analyses were also performed separately for DD and LD cohorts. The results were comparable, except that PKT was not a significant risk factor in the LD cohort (HR=0.82, P=0.12 for mortality and HR=0.83, P=0.051 for uncensored graft failure). However, in DD recipients, patient mortality (HR=0.70, P=0.004) and uncensored graft failure (HR=0.68, P0.001) were significantly reduced with PKT.PKT reduced the risk of patient mortality and uncensored graft failure in DD recipients. Our study confirms the advantages of PKT in an unselected end-stage renal disease population with a high prevalence of PKT. |
| Databáze: | OpenAIRE |
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