Kensinger Clark, Bian Aihua, Fairchild Meagan, Chen Guanhua, Lipworth Loren, Ikizler T Alp, Birdwell Kelly A
Department of Surgery, Vanderbilt University Medical Center, 1161 21st Avenue South, D4313 MCN, Nashville, TN, 37232, USA.
Department of Biostatistics, Vanderbilt University Medical Center, 2525 West End Avenue, Suite 11000, Nashville, TN, 37203, USA.
BMC Nephrol. 2016 Oct 22;17(1):160. doi: 10.1186/s12882-016-0369-5.
Endothelial dysfunction is an important precursor to the development of atherosclerosis, and has been suggested to play a role in the increased cardiovascular risk in patients with end stage renal disease. Endothelial function improves rapidly following post kidney transplantation, but the long term change remains unclear. Hypothesizing that endothelial function would remain improved long term post kidney transplantation, we evaluated the longitudinal change of endothelial function, measured by flow-mediated dilation (FMD) of the brachial artery, from months 1 to 24 post transplantation. Given the previously reported association of fibroblast growth factor 23 (FGF-23) with endothelial dysfunction, we also examined changes in the association between FGF-23 levels and the change in FMD following kidney transplantation.
We performed a prospective cohort study of 149 kidney transplant recipients, measuring endothelial function by FMD at months 1, 12, and 24 post-transplant. FGF-23 levels were measured at months 1 and 24 post-transplant. Linear mixed effects models were used to assess both the unadjusted and adjusted outcomes.
The cohort (mean age 49 ± 13 years) was 74 % male and 75 % white. The median FMD was 6.3 % (IQR: 3.4, 10.2), 5.4 % (IQR: 3.1, 8.5), and 5.6 % (IQR: 3.5, 9.1) at 1, 12, and 24 months, respectively. After adjustment for covariates, compared to month 1, no change occurred in FMD at 12 months (-0.66 %; 95 % CI: -1.81 %, 0.49 %; P = 0.262) or 24 months (-0.25 %; 95%CI: -1.76 %, 1.26 %; P = 0.746). FGF-23 decreased significantly over time (P = 0.024), but there was no significant association between FGF-23 and FMD (P = 0.799).
Endothelial function remained stable at 12 and 24 months from 1 month post-kidney transplant, indicating that the improved endothelial function seen with transplant is maintained up to 2 years post transplantation. There was also no significant association between FGF-23 and endothelial function following kidney transplantation.
内皮功能障碍是动脉粥样硬化发展的重要先兆，且已表明其在终末期肾病患者心血管风险增加中起作用。肾移植后内皮功能迅速改善，但长期变化仍不清楚。假设肾移植后内皮功能会长期保持改善，我们评估了移植后1至24个月通过肱动脉血流介导的血管舒张（FMD）测量的内皮功能的纵向变化。鉴于先前报道的成纤维细胞生长因子23（FGF - 23）与内皮功能障碍的关联，我们还研究了肾移植后FGF - 23水平与FMD变化之间关联的变化。
我们对149名肾移植受者进行了一项前瞻性队列研究，在移植后1、12和24个月通过FMD测量内皮功能。在移植后1个月和24个月测量FGF - 23水平。使用线性混合效应模型评估未经调整和调整后的结果。
该队列（平均年龄49±13岁）中74%为男性，75%为白人。FMD的中位数在1、12和24个月时分别为6.3%（四分位间距：3.4，10.2）、5.4%（四分位间距：3.1，8.5）和5.6%（四分位间距：3.5，9.1）。在对协变量进行调整后，与1个月相比，12个月时FMD无变化（-0.66%；95%置信区间：-1.81%，0.49%；P = 0.262）或24个月时FMD无变化（-0.25%；95%置信区间：-1.76%，1.26%；P = 0.746）。FGF - 23随时间显著下降（P = 0.024），但FGF - 23与FMD之间无显著关联（P = 0.799）。
肾移植后1个月起，12个月和24个月时内皮功能保持稳定，表明移植后观察到的内皮功能改善在移植后长达2年时仍得以维持。肾移植后FGF - 23与内皮功能之间也无显著关联。
