■意向治疗分析跟随患者从上市到死亡,不管他们的移植状态如何,并旨在提供一个更全面的成人实体器官移植进展的范围。
■许多研究表明,成人肾脏在等待名单和移植后存活率方面取得了进展,肝脏,心,和肺移植,但有必要为患者及其家人提供更全面的移植结果。
■单变量和多变量Cox回归分析用于分析肾脏列出的813,862名成年人的意向治疗生存率的因素,肝脏,心,和肺移植。Kaplan-Meier方法用于检查候补名单的变化,移植后,和治疗生存的意图。移植率比较采用χ2检验。
■肝脏的治疗意向生存率稳步增加,心,和肺移植。在1年内移植的患者的心脏(52.9%的57.4%)和肺(33.2%的73.5%)的百分比显着增加。然而,1年内接受肾移植的患者比例从35.8%显著下降至21.2%.值得注意的是,尽管等待名单和移植后存活率增加,但肾脏的意向治疗存活率下降,可能是因为移植率下降。
■肝脏的生存率稳步提高,心,和30年研究期间的肺移植。分配政策的不断进步,免疫抑制,对等待名单上的患者进行更好的护理可能有助于进一步改善所有器官的预后,但是供体肾脏的供需差异越来越大,这令人担忧,并阻碍了肾脏意向治疗生存率的提高。
UNASSIGNED: Intent-to-treat analysis follows patients from listing to death, regardless of their transplant status, and aims to provide a more holistic scope of the progress made in adult solid-organ transplantation.
UNASSIGNED: Many studies have shown progress in waitlist and post-transplant survival for adult kidney, liver, heart, and lung transplants, but there is a need to provide a more comprehensive perspective of transplant outcomes for patients and their families.
UNASSIGNED: Univariable and multivariable Cox regression analyses were used to analyze factors contributing to intent-to-treat survival in 813,862 adults listed for kidney, liver, heart, and lung transplants. The Kaplan-Meier method was used to examine changes in waitlist, post-transplant, and intent-to-treat survival. Transplantation rates were compared using χ2 tests.
UNASSIGNED: Intent-to-treat survival has steadily increased for liver, heart, and lung transplants. The percentage of patients transplanted within 1 year significantly increased for heart (57.4% from 52.9%) and lung (73.5% from 33.2%). However, the percentage of patients transplanted within 1 year significantly decreased from 35.8% to 21.2% for kidney transplant. Notably, intent-to-treat survival has decreased for kidneys despite increases in waitlist and post-transplant survival, likely because of the decreased transplant rate.
UNASSIGNED: Intent-to-treat survival steadily improved for liver, heart, and lung transplant over the 30-year study period. Continued advancements in allocation policy, immunosuppression, and improved care of patients on the waitlist may contribute to further progress in outcomes of all organs, but the increasing discrepancy in supply and demand of donor kidneys is alarming and has impeded the progress of kidney intent-to-treat survival.