Harold Simmons Center for Chronic Disease Research & Epidemiology, LA BioMed at Harbor- UCLA, Torrance, CA, USA.
Clin J Am Soc Nephrol. 2012 Nov;7(11):1859-71. doi: 10.2215/CJN.01910212. Epub 2012 Sep 6.
Mineral and bone disorders (MBDs) are common in long-term dialysis patients and are risk factors for unfavorable outcomes. The associations between pretransplant levels of MBD surrogates and outcomes after kidney transplantation are not clear.
DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: Data from the Scientific Registry of Transplant Recipients up to June 2007 were linked to the 5-year (July 2001-June 2006) cohort of a large dialysis organization in the United States. All dialysis patients who received a kidney transplant during this period were identified and divided into groups according to increments of pretransplant MBD markers. Unadjusted and multivariate adjusted predictors of transplant outcomes were examined.
The 11,776 patients were aged 47 ± 14 years and 39% were women. Compared with recipients with pretransplant time-averaged serum alkaline phosphatase of 80-120 U/L, recipients with pretransplant serum alkaline phosphatase of 120-160 and ≥160 U/L had 49% and 64% higher graft failure censored all-cause mortality in multivariable adjusted models. There was no significant association between time-averaged serum alkaline phosphatase categories and risk of death censored graft failure, delayed graft function (DGF), or acute rejection (AR). Compared with recipients with pretransplant time-averaged serum parathyroid hormone (PTH) levels of 150-300 pg/ml, there was no significant association with graft censored death among recipients with pretransplant serum PTH ≥800 pg/ml. In addition, the risk of graft failure, DGF, and AR did not show any association with time-averaged serum intact PTH level. There was no significant association between time-averaged serum calcium categories and risk of graft failure censored death, DGF, and AR.
In this cohort, hemodialysis patients with pretransplant serum alkaline phosphatase >120 U/L have unfavorable post-transplant mortality, whereas there was no association between serum PTH and serum calcium levels and post-transplant outcomes.
矿物质和骨代谢紊乱（MBD）在长期透析患者中很常见，是不良预后的危险因素。移植前 MBD 替代标志物水平与肾移植后结局之间的关系尚不清楚。
设计、地点、参与者和测量：截至 2007 年 6 月的科学移植受者登记处的数据与美国一个大型透析组织的 5 年（2001 年 7 月至 2006 年 6 月）队列相关联。在此期间接受肾移植的所有透析患者均被确定，并根据移植前 MBD 标志物的增量分为几组。检查了移植结局的未调整和多变量调整预测因素。
11776 例患者年龄为 47 ± 14 岁，39%为女性。与移植前血清碱性磷酸酶时间平均为 80-120 U/L 的患者相比，移植前血清碱性磷酸酶为 120-160 和≥160 U/L 的患者在多变量调整模型中，移植物失功和全因死亡率的风险分别高 49%和 64%。时间平均血清碱性磷酸酶类别与死亡风险之间没有显著关联，也没有与移植物失功、延迟移植物功能（DGF）或急性排斥（AR）相关。与移植前时间平均血清甲状旁腺激素（PTH）水平为 150-300 pg/ml 的患者相比，移植前血清 PTH≥800 pg/ml 的患者与移植物失功死亡之间没有显著关联。此外，PTH 完整水平与移植物失功、DGF 和 AR 的风险没有关联。时间平均血清钙类别与移植物失功死亡、DGF 和 AR 的风险之间没有显著关联。
在本队列中，移植前血清碱性磷酸酶>120 U/L 的血液透析患者移植后死亡率较高，而血清 PTH 和血清钙水平与移植后结局之间没有关联。
