Abbott Kevin C, Bucci Jay R, Cruess David, Taylor Allen J, Agodoa Lawrence Y C
Nephrology Service, Walter Reed Army Medical Center, Washington, DC, 20307-5001, USA.
J Am Soc Nephrol. 2002 Oct;13(10):2560-9. doi: 10.1097/01.asn.0000028800.84746.cb.
The impact of graft loss on acute coronary syndromes (ACS) after renal transplantation has not been studied in a national population. It was hypothesized that ACS might be more frequent after graft loss, as many of the benefits of a functioning allograft on metabolism and volume regulation would be lost. Data from the 2000 United States Renal Data System (USRDS) was used to conduct an historical cohort study of ACS in 14,237 patients who received renal transplants between April 1, 1995, and June 30, 1998, (followed until April 28, 2000) with valid information from CMS Form 2728, excluding patients with hospitalized ACS before renal transplant. Cox nonproportional regression models were used to calculate the time-dependent adjusted hazard ratio (AHR) of graft loss (censored for death) for time-to-first hospitalization for ACS (International Classification of Diseases 9th Modification Diagnosis Codes [ICD9] code 410.x or 411.x) occurring after transplant. The incidence of ACS was 12.1 per 1000 patient-years (PY) in patients after graft loss versus 6.5 per 1000 PY after transplantation (excluding patients with graft loss). As a time-dependent variable, graft loss had an AHR of 2.54 (95% confidence interval, 1.09 to 5.96; P = 0.031 by Cox regression). Other risk factors associated with ACS included diabetes, older recipient, and male recipient. Allograft rejection was NS. Renal transplant recipients share some of the risk factors for ACS with the general population. In addition, graft loss was identified as a unique risk factor for ACS in this population.
肾移植后移植物丢失对急性冠脉综合征（ACS）的影响尚未在全国范围内的人群中进行研究。据推测，移植物丢失后ACS可能更为常见，因为功能正常的同种异体移植物在代谢和容量调节方面的许多益处将会丧失。利用2000年美国肾脏数据系统（USRDS）的数据，对1995年4月1日至1998年6月30日期间接受肾移植的14237例患者（随访至2000年4月28日）进行了ACS的历史性队列研究，这些患者具有来自医疗保险和医疗补助服务中心（CMS）2728表格的有效信息，排除肾移植前已住院的ACS患者。采用Cox非比例回归模型计算移植后首次因ACS住院（国际疾病分类第九版修正诊断编码[ICD9]编码410.x或411.x）的时间至移植物丢失（以死亡为删失）的时间依赖性调整风险比（AHR）。移植物丢失患者的ACS发病率为每1000患者年（PY）12.1例，而移植后（不包括移植物丢失患者）为每1000 PY 6.5例。作为一个时间依赖性变量，移植物丢失的AHR为2.54（95%置信区间，1.09至5.96；Cox回归P = 0.031）。与ACS相关的其他危险因素包括糖尿病、受者年龄较大和男性受者。同种异体移植物排斥反应无统计学意义。肾移植受者与普通人群共享一些ACS的危险因素。此外，移植物丢失被确定为该人群中ACS的一个独特危险因素。
