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肾移植受者的长期生存
Long-Term Survival after Kidney Transplantation


Sundaram Hariharan ... 其他 • 2021.08.19

肾移植与长期透析相比的生存优势已经有充分阐述,但前提是终末期肾病患者被判定为适合接受移植1,2。截至2018年12月,美国有554,038名终末期肾病患者正在接受长期透析,229,887名患者已接受有功能的肾移植3。截至2021年2月,约有9.1万名患者正在等待肾移植4。最终结果是经过多年之后,一些移植肾会失功;提高移植受者的长期生存率是研究者、临床医师和患者的主要目标。图1给出了在可提高受者长期生存率的因素和事件中,可改变的肾脏供者、受者和移植肾因素及移植后事件。延长生存期将减少再次接受透析的患者数量,减少对再次移植的需求,增加可供等待移植患者移植的肾脏数量,缩短移植的整体等待时间,改善生活质量和延长寿命,并且减轻患者和医疗系统的经济负担。

 

图1. 肾脏供者、移植候选者和受者方面采取的,可影响受者长期生存的干预措施

AMR表示抗体介导的排斥反应,APOL1表示载脂蛋白1,CIT表示冷缺血时间,DDK表示死亡供者肾脏,DSA表示供者特异性抗体,ESKD表示终末期肾病,HCV表示丙型肝炎病毒,HIV表示人类免疫缺陷病毒,KDPI表示肾脏供者概况指数(Kidney Donor Profile Index),LDK表示活体供者肾脏,LDPE表示活体供者配对交换,PTLD表示移植后淋巴细胞增生性疾病,TCMR表示T细胞介导的排斥反应。

 

肾移植受者生存的各个方面涉及大量医护人员,包括初级保健医师和专科医师。这篇综述总结了自20世纪90年代中期以来,生存率、人口统计学特征和风险变量的变化。我们阐明了妨碍受者长期生存的移植后事件、与少数人种或族群受者相关的因素,以及免疫抑制剂医保覆盖的改善情况。





作者信息

Sundaram Hariharan, M.D., Ajay K. Israni, M.D., and Gabriel Danovitch, M.D.
From the University of Pittsburgh Medical Center, Pittsburgh (S.H.); Hennepin Healthcare, the University of Minnesota, and the Scientific Registry of Transplant Recipients — all in Minneapolis (A.K.I.); and the University of California, Los Angeles, Los Angeles (G.D.). Address reprint requests to Dr. Hariharan at the University of Pittsburgh Medical Center, 3459 Fifth Ave., 7S, Pittsburgh, PA 15213, or at hariharans@upmc.edu or shnephron@gmail.com.

 

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