Laging Mirjam, Kal-van Gestel Judith A, van de Wetering Jacqueline, IJzermans Jan N M, Betjes Michiel G H, Weimar Willem, Roodnat Joke I
1 Department of Internal Medicine, Erasmus Medical Center, Rotterdam, The Netherlands. 2 Department of General Surgery, Erasmus Medical Center, Rotterdam, The Netherlands.
Transplantation. 2016 Feb;100(2):400-6. doi: 10.1097/TP.0000000000000973.
Currently, potential kidney transplant patients more often suffer from comorbidities. The Charlson Comorbidity Index (CCI) was developed in 1987 and is the most used comorbidity score. We questioned to what extent number and severity of comorbidities interfere with graft and patient survival. Besides, we wondered whether the CCI was best to study the influence of comorbidity in kidney transplant patients.
In our center, 1728 transplants were performed between 2000 and 2013. There were 0.8% cases with missing values. Nine pretransplant comorbidity covariates were defined: cardiovascular disease, cerebrovascular accident, peripheral vascular disease, diabetes mellitus, liver disease, lung disease, malignancy, other organ transplantation, and human immunodeficiency virus positivity. The CCI used was unadjusted for recipient age. The Rotterdam Comorbidity in Kidney Transplantation score was developed, and its influence was compared to the CCI. Kaplan-Meier analysis and multivariable Cox proportional hazards analysis, corrected for variables with a known significant influence, were performed.
We noted 325 graft failures and 215 deaths. The only comorbidity covariate that significantly influenced graft failure censored for death was peripheral vascular disease. Patient death was significantly influenced by cardiovascular disease, other organ transplantation, and the total comorbidity scores. Model fit was best with the Rotterdam Comorbidity in Kidney Transplantation score compared to separate comorbidity covariates and the CCI. In the population with the highest comorbidity score, 50% survived more than 10 years.
Despite the negative influence of comorbidity, patient survival after transplantation is remarkably good. This means that even patients with extensive comorbidity should be considered for transplantation.
目前，潜在的肾移植患者常伴有合并症。查尔森合并症指数（CCI）于1987年制定，是最常用的合并症评分系统。我们想了解合并症的数量和严重程度在多大程度上会影响移植肾和患者的存活。此外，我们还想知道CCI是否最适合用于研究合并症对肾移植患者的影响。
在我们中心，2000年至2013年间共进行了1728例移植手术。缺失值的病例占0.8%。定义了9个移植前合并症协变量：心血管疾病、脑血管意外、外周血管疾病、糖尿病、肝脏疾病、肺部疾病、恶性肿瘤、其他器官移植以及人类免疫缺陷病毒阳性。所使用的CCI未针对受者年龄进行调整。开发了鹿特丹肾移植合并症评分，并将其影响与CCI进行比较。进行了Kaplan-Meier分析和多变量Cox比例风险分析，并对具有已知显著影响的变量进行了校正。
我们记录到325例移植肾失败和215例死亡。唯一对因死亡而 censored 的移植肾失败有显著影响的合并症协变量是外周血管疾病。心血管疾病、其他器官移植和合并症总分对患者死亡有显著影响。与单独的合并症协变量和CCI相比，鹿特丹肾移植合并症评分的模型拟合效果最佳。在合并症评分最高的人群中，50%的患者存活超过10年。
尽管合并症有负面影响，但移植后患者的存活率非常高。这意味着即使是合并症广泛的患者也应考虑进行移植。
