Aalten Jeroen, Hoogeveen Ellen K, Roodnat Joke I, Weimar Willem, Borm George F, de Fijter Johan W, Hoitsma Andries J
Department of Nephrology, Radboud University Medical Center Nijmegen, Nijmegen, The Netherlands.
Transpl Int. 2008 Oct;21(10):985-91. doi: 10.1111/j.1432-2277.2008.00717.x. Epub 2008 Jun 28.
The prevalence of cardiovascular risk factors in renal transplant candidates is high. A better understanding of the relation between these risk factors and cardiovascular morbidity and mortality is mandatory to improve transplantation outcome. In this retrospective cohort study 2187 adult patients who received a first kidney transplant between 1984 and 1997 were included. We analyzed the incidence of post-transplant cardiovascular events and tried to identify independent pretransplant risk factors for post-transplant cardiovascular events and all-cause mortality. The cumulative incidence of post-transplant cardiovascular events was 40%. The incidence was highest in the first 3 months after transplantation. Independent pretransplant risk factors for a post-transplant cardiovascular event were diabetic nephropathy [Hazard ratio (HR) 3.02; 95% CI 2.85-3.98], claudication [HR 2.17 (1.42-3.31)], cardiac event [HR 1.76 (1.32-2.33)], cerebrovascular accident HR 1.53 (1.03-2.28), time-on-dialysis [HR 1.06 (1.02-1.11)], recipient age [HR 1.04 (1.04-1.05)], and body mass index [HR 1.03 (1.00-1.05)]. Diabetic nephropathy and cardiovascular disease were also important predictors for all-cause mortality. Diabetic nephropathy and cardiovascular disease were the most important predictors for cardiovascular events and all-cause mortality after renal transplantation. Early treatment of cardiovascular risk factors and pretransplant cardiovascular evaluation might improve transplantation outcome.
肾移植候选者中心血管危险因素的患病率很高。更好地了解这些危险因素与心血管发病率和死亡率之间的关系对于改善移植结局至关重要。在这项回顾性队列研究中，纳入了1984年至1997年间接受首次肾移植的2187例成年患者。我们分析了移植后心血管事件的发生率，并试图确定移植前心血管事件和全因死亡率的独立危险因素。移植后心血管事件的累积发生率为40%。该发生率在移植后的前3个月最高。移植前心血管事件的独立危险因素包括糖尿病肾病[风险比（HR）3.02；95%可信区间2.85-3.98]、跛行[HR 2.17（1.42-3.31）]、心脏事件[HR 1.76（1.32-2.33）]、脑血管意外HR 1.53（1.03-2.28）、透析时间[HR 1.06（1.02-1.11）]、受者年龄[HR 1.04（1.04-1.05）]和体重指数[HR 1.03（1.00-1.05）]。糖尿病肾病和心血管疾病也是全因死亡率的重要预测因素。糖尿病肾病和心血管疾病是肾移植后心血管事件和全因死亡率的最重要预测因素。早期治疗心血管危险因素和移植前心血管评估可能会改善移植结局。
