Kolonko Aureliusz, Chudek Jerzy, Więcek Andrzej
Department of Nephrology, Transplantology and Internal Diseases, Medical University of Silesia, Katowice, Poland.
Department of Nephrology, Transplantology and Internal Diseases, Medical University of Silesia, Katowice, Poland Department of Pathophysiology, Medical University of Silesia, Katowice, Poland.
Nephrol Dial Transplant. 2015 Jul;30(7):1218-24. doi: 10.1093/ndt/gfv083. Epub 2015 Apr 2.
Cardiovascular complications remain the most frequent cause of death in kidney transplant recipients. We analysed the prognostic value of early measured resistance index (RI) in the aspect of long-term cardiovascular mortality. In order to eliminate potential donor-related confounders, we analysed the mortality of recipients, transplanted with organs procured from the same donor, in whom the initial RI values substantially differed.
Doppler sonography was performed in 725 consecutive kidney graft recipients early after transplantation. We identified 133 pairs (266 patients) who received their kidney grafts from the same donor and their initial RI values differed by >0.1.
During 109 ± 37 months of follow-up after transplantation, 84 patients lost their graft and 29 died, 14 of them due to cardiovascular causes. Two groups of paired patients with higher RI and lower RI did not differ significantly with respect to their age, BMI, HLA mismatch and cold ischaemia time. There were more patients with diabetes in the higher RI group (14.3 versus 6.8%). Survival analysis revealed a higher mortality for cardiovascular (8.3 versus 2.3%, P = 0.02) and all causes (14.3 versus 7.5%, P = 0.06) among patients with higher initial RI values. In the Cox regression model, not including age, a higher RI value was a strong predictor of cardiovascular death (HR = 4.88), independent of previous cardiovascular episodes (HR = 6.78). Both these variables lost its significance as a predictors after inclusion of age in the regression model.
Increased intrarenal resistance index in the early posttransplant period may help to identify the recipients with increased cardiovascular risk.
心血管并发症仍然是肾移植受者最常见的死亡原因。我们分析了早期测量的阻力指数（RI）在长期心血管死亡率方面的预后价值。为了消除潜在的供体相关混杂因素，我们分析了接受来自同一供体的器官移植且初始RI值存在显著差异的受者的死亡率。
对725例连续的肾移植受者在移植后早期进行多普勒超声检查。我们确定了133对（266例患者）接受来自同一供体的肾移植且其初始RI值相差>0.1的患者。
在移植后109±37个月的随访期间，84例患者移植肾失功，29例死亡，其中14例死于心血管原因。两组初始RI较高和较低的配对患者在年龄、体重指数、HLA错配和冷缺血时间方面无显著差异。初始RI较高组的糖尿病患者更多（14.3%对6.8%）。生存分析显示，初始RI值较高的患者心血管死亡率（8.3%对2.3%，P = 0.02）和全因死亡率（14.3%对7.5%，P = 0.06）更高。在不包括年龄的Cox回归模型中，较高的RI值是心血管死亡的强预测因子（HR = 4.88），独立于既往心血管事件（HR = 6.78）。在回归模型中纳入年龄后，这两个变量作为预测因子均失去了显著性。
移植后早期肾内阻力指数升高可能有助于识别心血管风险增加的受者。
