Matsumoto Cal, Swanson Sidney J, Agodoa Lawrence Y, Holtzmuller Kent C, Abbott Kevin C
Organ Transplantation Service, Walter Reed Army Medical Center, National Institutes of Health, Washington, DC, USA.
J Nephrol. 2003 Jan-Feb;16(1):49-56.
The risk of hospitalized gastrointestinal bleeding (GIB) in renal transplant recipients has not been studied in a national renal transplant population. Therefore, 42,906 renal transplant recipients in the United States Renal Data System (USRDS) from 1 July 1994 - 30 June 1998 were analyzed in an historical cohort study of hospitalizations with a primary discharge diagnosis of GIB (ICD9 Code 578.9x) using Cox regression analysis. The 1997 National Hospital Discharge Survey was used to obtain rates of GIB for the general population. Renal transplant recipients had a cumulative incidence of hospitalizations for GIB of 334 events/100,000 person-years. In 1997, compared to the general population, renal transplant recipients had an age-adjusted rate ratio for GIB of 10.69 at one year of follow-up. The strongest risk factors for GIB in Cox regression analysis were graft loss (adjusted hazard ratio, 4.28 (2.84-6.47) and African American recipients who experienced allograft rejection (AHR, 3.04, 95% CI, 1.45-6.37). GIB was associated with increased all-cause mortality (hazard ratio 1.78, 95% CI, 1.39-2.28). GIB is significantly more common in renal transplant recipients than in the general population, and the strongest risk factors are graft loss and African Americans who experience rejection.
尚未在全国肾移植人群中研究肾移植受者发生住院胃肠道出血（GIB）的风险。因此，在一项针对以GIB（国际疾病分类第九版代码578.9x）为主要出院诊断的住院病例的历史性队列研究中，对1994年7月1日至1998年6月30日期间美国肾脏数据系统（USRDS）中的42,906名肾移植受者进行了分析，采用Cox回归分析。利用1997年全国医院出院调查获取普通人群的GIB发生率。肾移植受者GIB住院的累积发病率为334例/100,000人年。1997年，与普通人群相比，肾移植受者在随访一年时GIB的年龄调整率比为10.69。Cox回归分析中GIB最强的危险因素是移植肾丢失（调整后的风险比，4.28（2.84 - 6.47））以及经历同种异体移植排斥反应的非裔美国受者（AHR，3.04，95%CI，1.45 - 6.37）。GIB与全因死亡率增加相关（风险比1.78，95%CI，1.39 - 2.28）。肾移植受者中GIB的发生率显著高于普通人群，最强的危险因素是移植肾丢失和经历排斥反应的非裔美国人。
