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研究生(外文):Chia-Yu Chang
論文名稱(外文):Outcomes of Renal Transplantation:Survival and Risk Factors
指導教授(外文):Chung-Fu Lan
外文關鍵詞:Renal transplantationSurvival analysisForeign kidney transplant
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方法:本研究使用全民健保資料庫,取得2000-2007年,於境內或境外僅接受過一次腎臟移植手術之患者,以卡方檢定探討各變數之關聯性,並以Kaplan -Meier存活函數及Cox比例危險複迴歸,分析腎臟移植之病患存活情形與腎臟存活情形。
Objectives: Kidney transplantation would be the best treatment of cost effectiveness for end-stage renal disease at this time; however, the world is facing the supply and demand problem of kidney. In Taiwan, though the government has strongly promoted organ donation, patients take the risks and meet all the expenses themselves to travel overseas to buy kidney just because of the very limited supply of kidney in our country. Although the use of either foreign or domestic kidney transplant operation to treat end-stage renal disease may reduce national health insurance expenditures, this may also result in unhealthy outcome, which may cause a long-term impact on the financial planning of national health insurance. Thus, we’ll explore and discuss the risk factors that affect the outcome of kidney transplantation in this thesis.
Methods: In this thesis, we find out all the patients who have received only once either domestic of foreign kidney transplantation within 2000 to 2007 from National Health Insurance Research Database and apply Chi-square test to show the inter-relationships of each variable. We also carry out an analysis of the patient survival and the kidney survival of the kidney recipients using Kaplan –Meier (Product-Limit) and Cox Multiple Proportional Hazard Regression.
Results: We find that there are 2,672 kidney recipients who have undergone only once kidney transplantation. According to the statistics, there is a great difference in most of the risk variables between patients with domestic kidney transplantation and those with foreign kidney transplantation. Care after surgery has a significant influence on both patient survival and kidney survival. On the other hand, patients’ characteristics, such as education level, the dialysis time before surgery and the comorbidity index affect the kidney survival but patient survival. Concerning the place of transplantation, patients with foreign transplantation has a higher survival rate within six years after renal transplantation than those with domestic transplantation. A reserved result is shown when concerning survival rate over six years after renal transplantation.
Conclusions: The outcome of kidney transplantation differs depend on patients characteristics, intervening condition of surgery, and care after surgery. Among all, care after surgery has the most influence on the outcome. Furthermore, there is a significant difference in the outcome between foreign and domestic transplantation.
論文電子檔著作權授權書 i
論文審定同意書 ii
致謝 iii
中文摘要 iv
英文摘要 v
目錄 vii
第一章 緒論 1
第一節 研究背景與與動機 1
第二節 研究目的 3
第三節 研究問題 4
第四節 研究重要性 5
第五節 重要名詞定義 6
第二章 文獻探討 7
第一節 腎臟移植現況 7
第二節 腎臟移植術後結果之相關研究 10
第三節 腎臟移植術後結果之主要影響因素 13
第三章 研究方法 16
第一節 研究設計與架構 16
第二節 研究假設 17
第三節 資料來源 18
第四節 研究變項及其測量 19
第五節 資料處理 29
第六節 統計分析方法 32
第四章 研究結果 33
第一節 歷年資料描述 33
第二節 各變項之相關性與獨立性 44
第三節 腎臟移植國家、腎臟移植情形與患者存活情形之比較 47
第四節 生命表及Kaplan-Meier存活函數 52
第五節 Cox比例危險複迴歸模型建立 56
第五章 討論 62
第一節 各因子之討論 62
第二節 研究目的與結果之探討 62
第三節 研究限制 63
第六章 結論與建議 65
參考文獻 67
附錄 69
附錄一 本研究使用之腎臟移植相關藥物及處置代碼表 69
附錄二 共病定義及代碼 70
附錄三 其他研究結果數據 71
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