台灣全身性紅斑性狼瘡病人之腎臟移植：全國性的流行病學及結果分析

Kidney transplantation in patients with systemic lupus erythematosus: a nationwide population-based epidemiology and outcome analysis in Taiwan

目的：研究台灣全身性紅斑性狼瘡病人接受腎臟移植後之存活率。方法：使用健保資料庫中從1997年4月至2006年12月間開始接受規則洗腎病人之資料，分析全身性紅斑性狼瘡接受腎臟移植患者之預後。結果：1073個全身性紅斑性狼瘡腎臟衰竭病人，其中有115個病人接受腎臟移植，平均年齡為35.5歲，女性比男性為4.23:1，1年及4年病人及移植腎臟之存活率為0.94/0.88（移植腎）及0.96/0.93（病人）。移植的狼瘡病人存活率較未接受移植之末期腎病狼瘡病人為佳（危險比hazard ratio = 0.35; 95%信賴區間 = 0.14-0.85; p=0.021），針對移植腎臟之Cox迴歸模型存活分析（Cox regression）不論病人的特性如性別、接受移植之年紀、等待腎移植的時間、經濟狀況、接受換腎前的腎臟替代治療法（血液透析或腹膜透析）、或病人並存疾病如糖尿病、B型肝炎、C型肝炎或乾燥症，皆未達統計上的差異。結論：臺灣全身性紅斑性狼瘡病人接受腎臟移植後有不錯的生命存活率及移植腎臟存活率。是否台灣狼瘡病人的預後較其他國家或西方人為佳仍有待後續研究證實。

Objective: To determine the epidemiology and outcome of patients with systemic lupus erythematosus (SLE) that underwent kidney transplantation in Taiwan. Methods: We retrieved data from the National Health Insurance Research Dataset (NHIRD) and included those patients with newly developed end-stage renal disease (ESRD) who were recognized as having underlying SLE between April 1997 and December 2006. Among these patients we analyzed clinical as well as graft outcome in renal transplant recipients and clinical outcome in those not undergoing renal transplantation. Results: 1073 SLE-ESRD patients, including 115 renal transplant recipients, were analyzed. The mean age on receiving renal allograft was 35.5 years, with a female to male ratio of 4.23:1. The 1-year and 4-year survival rates of the allografts (AS) and the recipients (RS) were 0.94/0.88 (AS) and 0.96/0.93 (RS), respectively. Clinical survival of transplant patients was superior to that of non-transplant patients (hazard ratio = 0.35; 95% CI = 0.14-0.85; p=0.021) after adjusting other major prognosis factors. Factors such as gender, age at transplantation, waiting time for the graft, economic status, pre-transplant renal replacement therapy (RRT) and co-morbidities with hepatitis B (HBV), hepatitis C (HCV), diabetes mellitus (DM) and/or sicca complex had no signifi cant effect on graft success or failure. Conclusion: The clinical and graft survival rates were good in lupus renal transplant recipients in Taiwan. Further in-depth comparison of these features with those of Caucasians or other Asian countries is mandatory to reach a defi nite conclusion.