Cov txiaj ntsig
Tshawb nrhiav
Peb tau txheeb xyuas 48 cov kev tshawb fawb tsim nyog rau qhov kev tshuaj xyuas qhov systematic no. txheej txheem ntawm kev kawm xaiv.
Nws yuav siv sij hawm ntev npaum li cas rau CISTANCHE ua haujlwm rau cov neeg mob raum?
Kawm yam ntxwv
Tag nrho 48 cov kev tshawb fawb tau soj ntsuam hauv kev tsim: 42 cov kev tshawb fawb tau rov qab los (ntawm 37 yog raws li kev sau npe nrog cov ntaub ntawv yav tom ntej), tsib txoj kev tshawb fawb tau yav tom ntej, 27 48 51 52 68, thiab ib qho kev tshawb fawb tsis muaj kev qhia meej txog lub sij hawm ntawm kev sau cov ntaub ntawv. 22 Peb caug-yim kev tshawb fawb tau ua raws li cov ntaub ntawv sau npe hauv tebchaws lossis cheeb tsam, peb yog kev tshawb fawb ntau, thiab xya yog ib qho kev kawm ib leeg. Hais txog qhov sawv cev ntawm thaj chaw, kev tshawb fawb tau ua nyob rau hauv Tebchaws Europe (n=24), North America (n=20), South America (n=3), thiab Oceania (n=1) ).
Cov yam ntxwv ntawm tus neeg mob
Kev tshawb fawb piv txwv muaj qhov sib txawv loj, xws li ntawm 81 txog 449937 (qhov nruab nrab 2040); Kev tso npe ntawm cov neeg koom nrog kev kawm muaj txij li xyoo 1971 txog xyoo 2016, thiab lub sijhawm ntev tshaj plaws ntawm kev taug qab yog li ntawm peb mus rau 25 xyoo. Nyob rau hauv tag nrho, 452119 cov neeg mob tau hloov pauv thiab 793731 cov neeg mob tos tos tseem nyob ntawm kev lim ntshav. Hauv kev tshawb fawb qhia txog kev sib deev, feem pua ntawm cov txiv neej cov neeg mobyog 61% (n{1}}/235789) nyob rau hauv pab pawg neeg hloov pauv thiab 59% (n=146991/248394) nyob rau hauv cov pab pawg neeg tos kev lim ntshav. Lub hnub nyoog nruab nrab ntawm cov neeg mob kuj tau sib piv ntawm ob pawg ntawm 51.1 (ntau 34-73) xyoo thiab 51.3 ({11}}) xyoo rau kev hloov pauv thiab lim ntshav rau cov neeg mob, feem.
Daim duab 1|Kawm kev xaiv rau kev tshuaj xyuas thiab kev tshuaj xyuas meta. Tx=transplantation; WL=cov npe tos
Kev kawm zoo
Qhov qhab nia zoo ntawm cov kev kawm tsim nyog raws li NOS nplai yog 8.5 (ntau 7-9) ntawm 9, sawv cev rau tag nrho cov ntaub ntawv soj ntsuam zoo (cov lus ntxiv B). Cov lus qhia ntxiv C qhia txog cov yam ntxwv ntawm kev kawm hauv paus, tus yam ntxwv ntawm tus neeg mob, thiab tag nrho cov qhab nia zoo. Cov ncauj lus kom ntxaws txog cov txheej txheem txheeb cais siv, thiabcovariates hloov kho rau, thoob plaws cov kev tshawb fawb tau muab rau hauv cov lus ntxiv D.
Txawm hais tias 44 cov kev tshawb fawb pom tau tias muaj txiaj ntsig zoo rau kev hloov pauv, 11 ntawm cov kev tshawb fawb no tau txheeb xyuas qhov stratum uas hloov pauv tsis muaj txiaj ntsig tseem ceeb tshaj qhov seem ntawm kev lim ntshav. Tsis muaj qhov sib txawv hauv cov neeg mob nrograum tsis ua haujlwmtshwm sim los ntawmglomerulonephritis mob25; cov neeg mob hnub nyoog 65-70 xyoo 28; cov neeg mob raum tsis ua haujlwm los ntawmntshav siablos yog keeb kwm ua rau 30; Cov neeg mob uas lub cev qhov ntsuas ntau dua lossis sib npaug rau 4135; Cov neeg mob hnub nyoog siab dua lossis sib npaug li 70 xyoo nrog raum tsis ua haujlwm los ntawmglomerulonephritis mob45; cov neeg mob tau txais cov qauv kev hloov pauv hloov pauv nrog cov neeg mob ntshav qab zib hom 49; cov neeg mob hnub nyoog siab dua lossis sib npaug li 70 xyoo ntawm kev lim ntshav ntawm 1990 thiab 199950; Cov neeg mob raug cais raws li kev pheej hmoo tsawg los ntawm American Society of Transplantation52; cov neeg mob uas muaj kab mob peripheral arterial tau txais cov neeg pub dawb allografts59 tuag; cov neeg mob hnub nyoog siab dua lossis sib npaug li 70 xyoo 67; thiab cov neeg mob uas muaj kab mob pulmonary mob ntev, muaj hnub nyoog ntau dua lossis sib npaug li 70 xyoo, lossis muaj lub raum tsis ua haujlwm los ntawm ntshav qab zib.58 Tsis muaj kev tshawb fawb tau piav qhia tag nrho cov kev pheej hmoo tuag tsawg dua cuam tshuam nrog kev lim ntshav, nrog 8% (n=4/48 ) ntawm cov kev tshawb fawb qhia tsis muaj qhov sib txawv ntawm kev muaj sia nyob mus ntev ntawm kev kho mob. Ob qho ntawm cov kev tshawb fawb no yog ib qho kev tshawb fawb ib leeg tau tshaj tawm tom qab xyoo 1975 tab sis sawv cev cov ntaub ntawv los ntawm 1970s thaum ntxov thiab zoo li yuav tsis yog tus sawv cev ntawm kev siv tshuaj kho mob niaj hnub no. pawg me me ntawm cov neeg mob (n=156) ntawm 1990 thiab 1997 uas tsis muaj kev soj ntsuam kev rov qab los.32 Thaum kawg, ib txoj kev tshawb fawb tau nthuav tawm cov ntaub ntawv ntawm cov neeg mob hnub nyoog siab dua lossis sib npaug rau 70 xyoo los ntawm Fabkis cov npe ntawm 2002 thiab 2013.63 Txawm hais tias txoj kev tshawb no pom tias qhov kev pheej hmoo nyob rau hauv pab pawg hloov pauv tau halved los ntawm cuaj lub hlis piv nrog rau cov pab pawg neeg lim ntshav, nws tsis txaus los cuam tshuam qhov siab.perioperative txaus ntshai cuam tshuam nrog kev hloov pauvthaum kawg ntawm lub sijhawm kawm (hli 36).
Kev tshuaj xyuas cov pov thawj
92% (n=44/48) ntawm cov kev tshawb fawb qhia ib tug tseem ceeb tag nrho lub sij hawm ntev (ib xyoos los yog ntau tshaj) ciaj sia taus tau txais txiaj ntsig los ntawm kev hloov pauv nrog rau kev lim ntshav. Peb caug-ib ntawm cov 44 cov kev tshawb fawb tau qhia txog kev hloov pauv kev phom sij rau tag nrho cov neeg tuag (kev phom sij feem ntau 0.18-0.73; 95% kev ntseeg siab ntau yam 0.08 rau 0.96). Yim qhov kev tshawb fawb tau tshaj tawm txog qhov kev pheej hmoo ntawm kev hloov pauv hauv lub sijhawm tsis sib xws,25 26 30 34 38 53 59 63, thiab txhua qhov pom tias muaj kev pheej hmoo tuag hauv cov neeg tau txais kev hloov pauv tau ntau dua li cov neeg mob ntshav qab zib uas tau tos tam sim tom qab hloov pauv (kev phom sij ntau yam 1.3-17.7 ntawm 0-30 hnub; 1.5-4.8 ntawm 0-3 hli). Txawm li cas los xij, nyob rau hauv tag nrho yim txoj kev tshawb fawb, qhov kev pheej hmoo tuag ntau ntxiv yog tshwm sim los ntawm kev pheej hmoo ntawm kev mob perioperative thiab postoperative txaus ntshai yog thaum kawg offset, thiab los ntawm ib xyoos qhov kev pheej hmoo tuag tau qis dua hauv cov neeg tau txais kev hloov pauv (kev phom sij ntau yam 0.19-0.49). Kaum plaub ntawm 44 cov kev tshawb fawb qhia txog kev kho cov txheeb ze muaj kev phom sij stratified los ntawm hom pub dawb. Nyob rau hauv txhua rooj plaub, qhov twg muaj kev sib piv, cov kev tshawb fawb tau tshaj tawm txog kev hloov pauv hloov pauv hloov pauv nyob rau hauv uas muab cov txiaj ntsig muaj sia nyob ntau dua li kev hloov pauv hloov pauv tus neeg tuag, 31 35 45 49 55 59 60 61 63 cov qauv txheej txheem pub dawb tshaj cov txheej txheem txuas ntxiv, 41 47 55 60 69 thiab thaum kawg tus kab mob siab C tus kab mob seronegative hla tus kab mob siab C tus kab mob seropositive pub dawb hloov pauv. 37 65 Paub meej
Cov ntaub ntawv tshwm sim nrog kev hloov pauv kev phom sij rau txhua txoj kev kawm thiab stratum yog muab rau hauv cov lus ntxiv D. Cov txiaj ntsig tau pom nyob rau hauv txhua tus neeg laus uas muaj hnub nyoog siab dua lossis sib npaug li 18 xyoo, cov neeg laus (Ntau dua lossis sib npaug rau 60,24 28 29 38 47 66 67 Ntau dua lossis sib npaug rau 65,28 55 58 61 thiab Ntau dua lossis sib npaug rau 7045 50 62), thiab cov pab pawg neeg rog rog (lub cev qhov ntsuas qhov hnyav dua lossis sib npaug rau 30), 35 ntshav qab zib raws li comorbidity, 43 44 58 systemic sclerosis, 39 kab mob peripheral arterial,43 60 thiab cov neeg mob seropositive rau kab mob siab C.65
Meta-analysis
Ntawm 18 cov kev tshawb fawb suav nrog hauv kev tshuaj ntsuam xyuas, 11 cov kev tshawb fawb tau nthuav tawm cov qauv kev hloov pauv uas qhia txog ob qho kev pheej hmoo (kev pheej hmoo txaus ntshai lossis tus txheeb ze txaus ntshai) thiab qhov tseeb (tus qauv yuam kev, P-tus nqi, lossis kev ntseeg siab ntawm lub sijhawm).30 31 34 36 42 50 61 62 64 66 67 Kev phom sij yog tsis tau tshaj tawm ncaj qha hauv xya qhov kev tshawb fawb thiab tau nthuav tawm los ntawm Kaplan-Meier txoj kev ciaj sia taus. Zuag qhia tag nrho, kev kwv yees kwv yees tau pom tias kev hloov pauv tau cuam tshuam nrog 55% qis dua qhov kev pheej hmoo tuag mus ntev rau cov neeg mob uas muajraum tsis ua haujlwmpiv nrog rau kev lim ntshav (kev phom sij piv 0.45,
95% kev ntseeg siab lub sijhawm 0.39 rau 0.54; P<0.001), as shown in fig 2. Heterogeneity was significant by the Q statistic (405, df=19; P<0.01) and by I2 (95.3%; P<0.01).
Kev tshuaj xyuas pab pawg
Txhawm rau tshawb xyuas qhov tseem ceeb heterogeneity, peb tau txheeb xyuas cov kev tshawb fawb los ntawm thaj chaw thaj chaw (sab av av loj; daim duab 2), hom pub dawb (ua neej nyob piv rau cov neeg tuag; daim duab 3), thiab hom pej xeem (nruab nrab piv rau cov hnub nyoog loj dua lossis sib npaug li 60 xyoo; fig 4). Qhov sib xyaw ua ke txaus ntshai rau lub sijhawm ntev, tag nrho cov neeg tuag rau cov neeg hloov pauv, piv nrog rau pawg neeg lim ntshav, yog qis tshaj hauv Oceania (n=1; txaus ntshai piv 0.19, {{11} }.17 rau 0.22), ua raws li North America (n=2; 0.34, 0.22 txog 0.53; Cochran Q statistic 2.81, P{ {22}}.09; I2=64.4%, P<0.01) and Europe (n=13; 0.49, 0.40 to 0.60; Cochran Q statistic 131.87,
P<0.01; I2=90.1%, P<0.01), which were comparable.
Txawm li cas los xij, qhov tshwm sim ntawm ob qhov kev hloov pauv tsis sib txawv hauv South America (n{{0}}}; 0.67, 0.33 txog 1.35; Cochran Q statistic=29.2, P<0.01; I2=93.2%, P<0.01). Although subgroup analyses by continent helped to explain some of the heterogeneity, it remained largely significant. Stratification by donor type showed living donor transplantation to have a
qis dua qhov kev pheej hmoo tuag mus ntev piv nrog cov neeg hloov pauv hloov pauv tuag, nrog kev phom sij ntawm 0.30 (0.23 rau 0.39) thiab {{9} }.45 (0.38 rau 0.55), feem. Txawm li cas los xij, qhov tshwm sim tsis yog qhov tseem ceeb vim muaj kev sib txuam ntawm kev ntseeg siab thiab tsuas yog ib qho kev tshawb fawb pab txhawb cov ntaub ntawv rau kev hloov pauv hloov pauv hloov pauv nyob. Tsis tas li ntawd, qhov kev ntsuam xyuas no kuj tsis tuaj yeem suav
rau qhov tseem ceeb heterogeneity tam sim no. Thaum kawg, stratification los ntawm cov pej xeem hom pom ib tug zoo sib xws rau yav dhau los pab pawg neeg analyses, nrog rau ob qho tag nrho (kev phom sij piv {{0}}}.47, 0.38 rau 0.59 ) thiab ntau dua lossis sib npaug rau 60- xyoo pawg (0.42, 0.34 txog 0.53) qhia txog kev hloov pauv raws li qhov kev pheej hmoo tuag tsawg dua piv nrog kev lim ntshav; Txawm li cas los xij, stratification ua tsis tiav los piav qhia qhov ua rau ntawm qhov tseem ceeb heterogeneity.
Daim duab 2|Cov phiaj xwm hav zoov ntawm kev phom sij (nrog 95% kev ntseeg siab lub sijhawm (CIs)) rau kev hloov pauv piv rau cov npe hu ua waitlisted dialysis, stratified los ntawm thaj chaw. lnHR=log hazard ratio; seHR=tus qauv yuam kev txaus ntshai piv
