Imoagene-Oyedeji Anikphe E, Rosas Sylvia E, Doyle Alden M, Goral Simin, Bloom Roy D
Department of Medicine, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania 19104-6144, USA.
J Am Soc Nephrol. 2006 Nov;17(11):3240-7. doi: 10.1681/ASN.2006010027. Epub 2006 Oct 11.
Although posttransplantation anemia (PTA) is common in the mycophenolate mofetil era, its impact on patient survival is unknown. This retrospective cohort study characterized factors that are associated with PTA 12 mo after transplantation in mycophenolate mofetil-treated kidney recipients and explored whether 12-mo PTA affects outcomes. The records of 626 kidney recipients were examined for presence of anemia (hemoglobin <12 g/dl). Multivariate regression models, fit with covariates that had unadjusted relationships, investigated both risk factors for 12-mo PTA and whether 12-mo PTA contributes to mortality. Anemia prevalence was 72, 40, and 20.3% at 1, 3, and 12 mo, respectively. By multivariate logistic regression, anemia at 3 mo (odds ratio [OR] 10.0; 95% confidence interval [CI] 5.3 to 17.1; P = 0.0001), donor age (OR 1.0; 95% CI 1.1 to 1.3; P = 0.005), and 3-mo creatinine (OR 2.0; 95% CI 1.2 to 3.3; P = 0.044) were associated with 12-mo PTA. The PTA cohort had inferior patient survival (P = 0.02, log rank) and a higher proportion of cardiovascular deaths (6.3 versus 2.2%; P = 0.017) than nonanemic patients. By Cox regression, 12-mo PTA (hazard ratio [HR] 3.0; 95% CI 1.3 to 6.7; P = 0.009), 12-mo creatinine (HR 1.3; 95% CI 1.1 to 1.4; P = 0.008), age at transplantation (HR 1.1; 95% CI 1.1 to 1.2; P = 0.004), and hepatitis C seropositivity (HR 2.8; 95% CI 1.1 to 7.0; P = 0.03) were associated with mortality. There was no interaction between 12-mo PTA and serum creatinine. In conclusion, 12-mo PTA is associated with an increased risk for patient death. The presence of anemia 3 mo after kidney transplantation is a major determinant of 12-mo PTA. PTA in kidney recipients therefore should be defined by its persistence or occurrence beyond the third posttransplantation month.
虽然移植后贫血（PTA）在霉酚酸酯时代很常见，但其对患者生存的影响尚不清楚。这项回顾性队列研究确定了霉酚酸酯治疗的肾移植受者移植后12个月与PTA相关的因素，并探讨了12个月时的PTA是否会影响预后。检查了626例肾移植受者的记录，以确定是否存在贫血（血红蛋白<12 g/dl）。多变量回归模型结合了具有未调整关系的协变量，研究了12个月时PTA的危险因素以及12个月时的PTA是否会导致死亡。贫血患病率在1、3和12个月时分别为72%、40%和20.3%。通过多变量逻辑回归分析，3个月时的贫血（比值比[OR]为10.0；95%置信区间[CI]为5.3至17.1；P = 0.0001）、供体年龄（OR为1.0；95% CI为1.1至1.3；P = 0.005）和3个月时的肌酐（OR为2.0；95% CI为1.2至3.3；P = 0.044）与12个月时的PTA相关。与非贫血患者相比，PTA队列的患者生存率较低（P = 0.02，对数秩检验），心血管死亡比例较高（6.3%对2.2%；P = 0.017）。通过Cox回归分析，12个月时的PTA（风险比[HR]为3.0；95% CI为1.3至6.7；P = 0.009）、12个月时的肌酐（HR为1.3；95% CI为1.1至1.4；P = 0.008）、移植时的年龄（HR为1.1；95% CI为1.1至1.2；P = 0.004）和丙型肝炎血清学阳性（HR为2.8；95% CI为1.1至7.0；P = 0.03）与死亡率相关。12个月时的PTA与血清肌酐之间没有相互作用。总之，12个月时的PTA与患者死亡风险增加相关。肾移植后3个月时贫血的存在是12个月时PTA的主要决定因素。因此，肾移植受者的PTA应以移植后第三个月后持续存在或发生来定义。
