Lemmers M J, Barry J M
Division of Urology and Renal Transplantation, Oregon Health Sciences University, Portland 97201.
Diabetes Care. 1991 Apr;14(4):295-301. doi: 10.2337/diacare.14.4.295.
To identify clinical characteristics of diabetic end-stage renal disease patients that place individual transplant candidates at high risk for arterial morbidity and mortality after transplantation.
We studied the course of 101 sequential renal allograft recipients with insulin-dependent diabetes mellitus, transplanted between 10 November 1980 and 1 April 1986. Arterial disorders were tabulated from medical records and interviews with individual patients, their families, and their private physicians. Documentation of discrete arterial events included recorded physical examinations, radiographic studies, laboratory data, electrocardiograms, peripheral vascular flow studies, and operative reports. The prevalence of preoperative arterial disease was compared with the occurrence of new arterial events after kidney transplantation.
Within a mean follow-up period of 47 mo, a 30% absolute mortality rate was observed. Of these deaths, 57% resulted from arterial disorders. Clinical manifestations of arterial disease were recognized in 41% of recipients before transplantation, and 78% of these patients suffered new vascular events after transplantation. Of the entire sample, 57% developed at least one new complication of arterial disease after transplantation, whereas only 34% had no vascular diagnosis before or after transplantation. Cerebral, coronary, and peripheral arterial complications after transplantation occurred in 14, 28, and 36% of the patients, respectively. The corresponding incidences of stroke, myocardial infarction, and amputation were 12, 14, and 25%. Pretransplant coronary artery disease predisposed to new coronary events after transplantation, but only peripheral arterial complications occurred more often after transplantation compared with the preoperative period. The probability of arterial complications or death correlated with patient age at first transplant and duration of diabetes but not with sex or smoking history.
Intrinsic arterial disease in diabetic renal allograft recipients contributes heavily to the long-term morbidity and mortality after transplantation and poses the major threat to survival. Diabetic transplant candidates greater than 35 yr of age or with clinical evidence of arterial disease should undergo an extensive vascular assessment, including stress thallium myocardial imaging and/or coronary arteriography. Such recipients should receive careful preoperative counseling about their excess risk for subsequent arterial disorders.
确定糖尿病终末期肾病患者的临床特征，这些特征会使个体移植受者在移植后发生动脉病变和死亡的风险增高。
我们研究了1980年11月10日至1986年4月1日期间连续接受肾移植的101例胰岛素依赖型糖尿病患者的病程。从病历以及对患者本人、其家属和私人医生的访谈中整理出动脉疾病情况。离散动脉事件的记录包括记录的体格检查、影像学研究、实验室数据、心电图、外周血管血流研究和手术报告。将术前动脉疾病的患病率与肾移植后新动脉事件的发生率进行比较。
在平均47个月的随访期内，观察到绝对死亡率为30%。在这些死亡病例中，57%是由动脉疾病导致的。41%的受者在移植前被发现有动脉疾病的临床表现，其中78%的患者在移植后发生了新的血管事件。在整个样本中，57%的患者在移植后发生了至少一种新的动脉疾病并发症，而只有34%的患者在移植前后均无血管疾病诊断。移植后脑血管、冠状动脉和外周动脉并发症分别发生在14%、28%和36%的患者中。相应的中风、心肌梗死和截肢发生率分别为12%、14%和25%。移植前的冠状动脉疾病易导致移植后发生新的冠状动脉事件，但与术前相比，只有外周动脉并发症在移植后更常发生。动脉并发症或死亡的概率与首次移植时的患者年龄和糖尿病病程相关，但与性别或吸烟史无关。
糖尿病肾移植受者的内在动脉疾病在很大程度上导致了移植后的长期发病率和死亡率，并对生存构成主要威胁。年龄大于35岁或有动脉疾病临床证据的糖尿病移植候选者应接受全面的血管评估，包括负荷铊心肌显像和/或冠状动脉造影。此类受者应在术前就其随后发生动脉疾病的额外风险接受仔细的咨询。
