本文由小咖机器人翻译整理

期刊来源：JAMA

原文链接：https://doi.org/10.1001/jama.2024.8469

摘要内容如下：

重要性

在肾脏捐赠之前接受透析的死亡捐赠者的肾脏移植后的受体结果没有得到很好的描述。

目的

比较在肾脏捐献前接受透析的死亡供体肾脏移植的受者与未接受透析的死亡供体肾脏移植的受者的结果。

设计、设置和参与者

进行了一项回顾性队列研究，包括来自58个美国器官获取组织的死亡肾脏捐献者和肾移植受者的数据。从2010年到2018年，共确定了805名在肾脏捐献前接受透析的捐献者。在肾脏捐献前接受透析的捐献者与未接受透析的捐献者使用基于等级的距离矩阵算法进行1:1匹配；对1944名肾移植受者进行了评估。

曝光

在肾脏捐赠前接受透析的已故捐赠者的肾脏移植与未接受透析的已故捐赠者的肾脏移植的比较。

主要成果和措施

4项研究结果为移植肾功能延迟恢复（定义为肾移植受者在移植后≤1周接受透析）、全因移植失败、死亡删失移植失败和死亡。

结果

从2010年到2018年，1.4%的已故肾脏捐献者（58155人中的805人）在肾脏捐献前接受了透析。在这805人中，523人（65%）捐献了至少1个肾脏。共有969个肾脏（60%）被移植，641个肾脏（40%）被丢弃。在肾移植供者中，514例（平均年龄33岁[SD，10.8岁]；98人患有高血压[19.1%]，36人患有糖尿病[7%]）在捐赠前接受透析，并与514人（平均年龄33岁[SD，10.9岁]；98名高血压患者（19.1%）和36名糖尿病患者（7%）未接受透析。与来自未接受透析的供体（n=990）的肾移植（n=990）相比，来自捐献前接受透析的供体（n=954）的肾移植与更高的移植功能延迟风险相关（分别为59.2%和24.6%；调整后的比值比为4.17[95%CI，3.28-5.29]）。在中位随访34.1个月时，全因移植失败的发生率没有显著差异（捐献前接受透析的供体每1000人-年43.1例肾移植，而未接受透析的供体每1000人-年46.9例肾移植；校正风险比[HR]，0.90[95%CI，0.70-1.15]），死亡删失移植失败（分别为22.5 vs 20.6/1000人-年；校正HR，1.18[95%CI，0.83-1.69]），或死亡（24.6 vs 30.8/1000人-年；校正HR，0.76[95%CI，0.55-1.04]）。

结论和相关性

与接受未接受透析的死亡供体的肾脏相比，接受在肾脏捐赠前接受透析的死亡供体的肾脏与移植肾功能延迟的发生率显著较高相关，但在随访时移植肾衰竭或死亡方面无显著差异。

英文原文如下：

Abstracts

Importance  Recipient outcomes after kidney transplant from deceased donors who received dialysis prior to kidney donation are not well described.

Objective  To compare outcomes of transplant recipients who received kidneys from deceased donors who underwent dialysis prior to kidney donation vs recipients of kidneys from deceased donors who did not undergo dialysis.

Design, Setting, and Participants  A retrospective cohort study was conducted including data from 58 US organ procurement organizations on deceased kidney donors and kidney transplant recipients. From 2010 to 2018, 805 donors who underwent dialysis prior to kidney donation were identified. The donors who underwent dialysis prior to kidney donation were matched 1:1 with donors who did not undergo dialysis using a rank-based distance matrix algorithm; 1944 kidney transplant recipients were evaluated.

Exposure  Kidney transplants from deceased donors who underwent dialysis prior to kidney donation compared with kidney transplants from deceased donors who did not undergo dialysis.

Main Outcomes and Measures  The 4 study outcomes were delayed graft function (defined as receipt of dialysis by the kidney recipient ≤1 week after transplant), all-cause graft failure, death-censored graft failure, and death.

Results  From 2010 to 2018, 1.4% of deceased kidney donors (805 of 58 155) underwent dialysis prior to kidney donation. Of these 805 individuals, 523 (65%) donated at least 1 kidney. A total of 969 kidneys (60%) were transplanted and 641 kidneys (40%) were discarded. Among the donors with kidneys transplanted, 514 (mean age, 33 years [SD, 10.8 years]; 98 had hypertension [19.1%] and 36 had diabetes [7%]) underwent dialysis prior to donation and were matched with 514 (mean age, 33 years [SD, 10.9 years]; 98 had hypertension [19.1%] and 36 had diabetes [7%]) who did not undergo dialysis. Kidney transplants from donors who received dialysis prior to donation (n = 954 kidney recipients) were associated with a higher risk of delayed graft function compared with kidney transplants from donors who did not receive dialysis (n = 990 kidney recipients) (59.2% vs 24.6%, respectively; adjusted odds ratio, 4.17 [95% CI, 3.28-5.29]). The incidence rates did not significantly differ at a median follow-up of 34.1 months for all-cause graft failure (43.1 kidney transplants per 1000 person-years from donors who received dialysis prior to donation vs 46.9 kidney transplants per 1000 person-years from donors who did not receive dialysis; adjusted hazard ratio [HR], 0.90 [95% CI, 0.70-1.15]), for death-censored graft failure (22.5 vs 20.6 per 1000 person-years, respectively; adjusted HR, 1.18 [95% CI, 0.83-1.69]), or for death (24.6 vs 30.8 per 1000 person-years; adjusted HR, 0.76 [95% CI, 0.55-1.04]).

Conclusions and Relevance  Compared with receiving a kidney from a deceased donor who did not undergo dialysis, receiving a kidney from a deceased donor who underwent dialysis prior to kidney donation was associated with a significantly higher incidence of delayed graft function, but no significant difference in graft failure or death at follow-up.

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