Department of Surgery, University of California, San Francisco, CA, USA.
Am J Transplant. 2012 Aug;12(8):2181-7. doi: 10.1111/j.1600-6143.2012.04077.x. Epub 2012 Apr 30.
With increasing short-term survival, the transplant community has turned its focus to delineating the impact of medical comorbidities on long-term outcomes. Unfortunately, conditions such as diabetes, hypertension and hyperlipidemia are difficult to track and often managed outside of the transplant center by primary care providers. We collaborated with Kaiser Permanente Northern California to create a database of 598 liver transplant recipients, which incorporates diagnostic codes along with laboratory and pharmacy data. Specifically, we determined the prevalence of diabetes, hypertension and hyperlipidemia both before and after transplant and evaluated the influence of disease duration as a time-dependent covariate on posttransplant survival. The prevalence of these comorbidities increased steadily from the time of transplant to 7 years after transplant. The estimated risk for all-cause mortality (hazard ratio = 1.07 per year increment, 95% CI 1.01-1.13, p < 0.02) and mortality secondary to cardiovascular events, infection/multisystem organ failure and allograft failure (hazard ratio = 1.08 per year increment, 95% CI 1.00-1.16, p = 0.05) increased for each additional year of diabetes. No associations were found for duration of hypertension and hyperlipidemia. Greater attention to management of diabetes may mitigate its negative impact on long-term survival in liver transplant recipients.
随着短期存活率的提高，移植界已将重点转向阐明医疗合并症对长期结果的影响。不幸的是，糖尿病、高血压和高血脂等疾病难以跟踪，并且通常由初级保健提供者在移植中心之外进行管理。我们与 Kaiser Permanente Northern California 合作创建了一个包含 598 名肝移植受者的数据库，该数据库结合了诊断代码以及实验室和药房数据。具体来说，我们确定了移植前后糖尿病、高血压和高血脂的患病率，并评估了疾病持续时间作为时间相关协变量对移植后生存的影响。这些合并症的患病率从移植时到移植后 7 年稳步上升。全因死亡率的估计风险（风险比=每年增加 1.07，95%CI 1.01-1.13，p<0.02）和心血管事件、感染/多器官衰竭和移植物衰竭导致的死亡率（风险比=每年增加 1.08，95%CI 1.00-1.16，p=0.05）随着糖尿病的每增加一年而增加。高血压和高血脂的持续时间没有发现关联。更加关注糖尿病的管理可能会减轻其对肝移植受者长期生存的负面影响。
