1 Nephrology Department, Carlos Haya Regional University Hospital and University of Malaga, Málaga, Spain. 2 Transplant Coordinator Center and Andalusian Health Service, Seville, Spain. 3 Clinic Biostatistic Unit, Hospital Ramón y Cajal IRYCIS, CIBERESP, Madrid, Spain.
Transplantation. 2017 Jun;101(6):1320-1326. doi: 10.1097/TP.0000000000001294.
The association between peripheral vascular disease (PVD) and survival among kidney transplant (KT) candidates is uncertain.
We assessed 3851 adult KT candidates from the Andalusian Registry between 1984 and 2012. Whereas 1975 patients received a KT and were censored, 1876 were on the waiting list at any time. Overall median waitlist time was 21.2 months (interquartile range, 11-37.4). We assessed the association between PVD and mortality in waitlisted patients using a multivariate Cox regression model, with a competing risk approach as a sensitivity analysis.
Peripheral vascular disease existed in 308 KT candidates at waitlist entry. The prevalence of PVD among nondiabetic and diabetic patients was 4.5% and 25.3% (P < 0.0001). All-cause mortality was higher in candidates with PVD (45% vs 21%; P < 0.0001). Among patients on the waiting list (n = 1876) who died (n = 446; 24%), 272 (61%) died within 2 years after listing. Cumulative incidence of all-cause mortality at 2 years in patients with and without PVD was 23% and 6.4%, respectively (P < 0.0001); similar differences were observed in patients with and without diabetes. By competing risk models, PVD was associated with a 1.9-fold increased risk of mortality (95% confidence interval [95% CI], 1.4-2.5). This association was stronger in waitlisted patients without cardiac disease (subhazard ratio, 2.2; 95% CI, 1.6-3.1) versus those with cardiac disorders (subhazard ratio, 1.5; 95% CI, 0.9-2.5). No other significant interactions were observed. Similar results were seen after excluding diabetics.
Peripheral vascular disease is a strong predictor of mortality in KT candidates. Identification of PVD at list entry may contribute to optimize targeted therapeutic interventions and help prioritize high-risk KT candidates.
外周血管疾病（PVD）与肾移植（KT）候选者的生存率之间的关系尚不确定。
我们评估了 1984 年至 2012 年间安达卢西亚登记处的 3851 名成年 KT 候选者。1975 名患者接受了 KT 并被删失，1876 名患者随时在等待名单上。总的中位等待时间为 21.2 个月（四分位距，11-37.4）。我们使用多变量 Cox 回归模型评估了 PVD 在等待名单上的患者中的死亡率之间的关系，并使用竞争风险方法进行了敏感性分析。
在等待名单上的 308 名 KT 候选者中存在 PVD。非糖尿病和糖尿病患者的 PVD 患病率分别为 4.5%和 25.3%（P <0.0001）。患有 PVD 的患者全因死亡率更高（45% vs 21%；P <0.0001）。在等待名单上的 1876 名患者（n=446；24%）中死亡的患者中，有 272 名（61%）在列出后 2 年内死亡。患有和不患有 PVD 的患者在 2 年内全因死亡率的累积发生率分别为 23%和 6.4%（P <0.0001）；在患有和不患有糖尿病的患者中也观察到类似的差异。通过竞争风险模型，PVD 与死亡率增加 1.9 倍相关（95%置信区间[95%CI]，1.4-2.5）。在没有心脏疾病的等待名单患者中，这种关联更强（亚危险比，2.2；95%CI，1.6-3.1），而在有心脏疾病的患者中，亚危险比为 1.5（95%CI，0.9-2.5）。未观察到其他显著的相互作用。排除糖尿病患者后也得到了相似的结果。
PVD 是 KT 候选者死亡率的强预测指标。在列入名单时发现 PVD 可能有助于优化有针对性的治疗干预，并有助于确定高危 KT 候选者。
