Harold Simmons Center for Chronic Disease Research and Epidemiology, Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center, Torrance, CA, USA.
Am J Transplant. 2011 May;11(5):1006-15. doi: 10.1111/j.1600-6143.2011.03480.x. Epub 2011 Mar 30.
The association between pretransplant serum albumin concentration and post-transplant outcomes in kidney transplant recipients is unclear. We hypothesized that in transplant-waitlisted hemodialysis patients, lower serum albumin concentrations are associated with worse post-transplant outcomes. Linking the 5-year patient data of a large dialysis organization (DaVita) to the Scientific Registry of Transplant Recipients, we identified 8961 hemodialysis patients who underwent first kidney transplantation. Mortality or graft failure and delayed graft function (DGF) risks were estimated by Cox regression (hazard ratio [HR]) and logistic regression (Odds ratio [OR]), respectively. Patients were 48 ± 13 years old and included 37% women and 27% diabetics. The higher pretransplant serum albumin was associated with lower mortality, graft failure and DGF risk even after multivariate adjustment for case-mix, malnutrition-inflammation complex and transplant related variable. Every 0.2 g/dL higher pretransplant serum albumin concentration was associated with 13% lower all-cause mortality (HR = 0.87 [95% confidence interval: 0.82-0.93]), 17% lower cardiovascular mortality (HR = 0.83[0.74-0.93]), 7% lower combined risk of death or graft failure (HR = 0.93[0.89-0.97]) and 4% lower DGF risk (OR = 0.96[0.93-0.99]). Hence, lower pretransplant serum albumin level is associated with worse post-transplant outcomes. Clinical trials to examine interventions to improve nutritional status in transplant-waitlisted hemodialysis patients and their impacts on post-transplant outcomes are indicated.
移植前血清白蛋白浓度与肾移植受者移植后结局的关系尚不清楚。我们假设，在移植等待的血液透析患者中，较低的血清白蛋白浓度与移植后结局较差相关。我们将一个大型透析机构（DaVita）的 5 年患者数据与移植受者登记处相联系，确定了 8961 例接受首次肾移植的血液透析患者。通过 Cox 回归（风险比 [HR]）和 logistic 回归（比值比 [OR]）分别估计死亡率或移植物失败和延迟移植物功能（DGF）风险。患者年龄为 48 ± 13 岁，包括 37%的女性和 27%的糖尿病患者。即使在多变量调整了病例组合、营养不良-炎症综合征和移植相关变量后，较高的移植前血清白蛋白水平仍与较低的死亡率、移植物失败和 DGF 风险相关。移植前血清白蛋白浓度每升高 0.2 g/dL，全因死亡率降低 13%（HR = 0.87 [95%置信区间：0.82-0.93]），心血管死亡率降低 17%（HR = 0.83[0.74-0.93]），死亡或移植物失败的综合风险降低 7%（HR = 0.93[0.89-0.97]），DGF 风险降低 4%（OR = 0.96[0.93-0.99]）。因此，较低的移植前血清白蛋白水平与移植后结局较差相关。需要进行临床试验来检查改善移植等待的血液透析患者营养状况的干预措施及其对移植后结局的影响。
