Cheungpasitporn Wisit, Thongprayoon Charat, Mitema Donald G, Mao Michael A, Sakhuja Ankit, Kittanamongkolchai Wonngarm, Gonzalez-Suarez Maria L, Erickson Stephen B
Division of Nephrology and Hypertension, Mayo Clinic, Rochester, Minnesota, USA.
Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, Minnesota, USA.
J Nephropathol. 2017 Jul;6(3):110-117. doi: 10.15171/jnp.2017.19. Epub 2017 Jan 30.
The use of aspirin in chronic kidney disease (CKD) patients has been shown to reduce myocardial infarction but may increase major bleeding. However, its effects in kidney transplant recipients are unclear.
A literature search was performed using MEDLINE, EMBASE, and Cochrane Database of Systematic Reviews from inception through September 2016. We included studies that reported odd ratios, relative risks or hazard ratios comparing outcomes of aspirin use in kidney transplant recipients. Pooled risk ratios (RR) and 95% confidence interval (CI) were assessed using a random-effect, generic inverse variance method.
We included 9 studies; enrolling 19759 kidney transplant recipients that compared aspirin with no treatment. Compared to no treatment, aspirin reduced the risk of allograft failure (4 studies; RR: 0.57, 95% CI: 0.33 to 0.99), allograft thrombosis (2 studies; RR: 0.11, 95% CI: 0.02 to 0.53), and major adverse cardiac events (MACEs) or mortality (2 studies; RR: 0.72, 95% CI: 0.59 to 0.88), but not allograft rejection (3 studies; RR: 0.86, 95% CI: 0.45 to 1.65) or delayed graft function (DGF) (2 studies; RR: 1.00, 95% CI: 0.58 to 1.72) in kidney transplant recipients. The data on risk of major or minor bleeding were limited.
Our meta-analysis demonstrates that administration of aspirin in kidney transplant recipients is associated with reduced risks of allograft failure, allograft thrombosis, and MACEs or mortality, but not allograft rejection or DGF. Future studies are needed to assess the risk of bleeding, and ultimately weigh the overall risks and benefits of aspirin use in specific kidney transplant patient populations.
已证明慢性肾脏病（CKD）患者使用阿司匹林可降低心肌梗死风险，但可能增加大出血风险。然而，其在肾移植受者中的作用尚不清楚。
使用MEDLINE、EMBASE和Cochrane系统评价数据库进行文献检索，检索时间从数据库创建至2016年9月。我们纳入了报告肾移植受者使用阿司匹林与未治疗相比的比值比、相对风险或风险比的研究。采用随机效应、通用逆方差法评估合并风险比（RR）和95%置信区间（CI）。
我们纳入了9项研究，共19759名肾移植受者，这些研究比较了阿司匹林与未治疗的情况。与未治疗相比，阿司匹林降低了移植肾失功风险（4项研究；RR：0.57，95%CI：0.33至0.99）、移植肾血栓形成风险（2项研究；RR：0.11，95%CI：0.02至0.53）以及主要不良心脏事件（MACE）或死亡风险（2项研究；RR：0.72，95%CI：0.59至0.88），但未降低肾移植受者的移植肾排斥反应风险（3项研究；RR：0.86，95%CI：0.45至1.65）或移植肾功能延迟恢复（DGF）风险（2项研究；RR：1.00，95%CI：0.58至1.72）。关于大出血或小出血风险的数据有限。
我们的荟萃分析表明，肾移植受者使用阿司匹林与移植肾失功、移植肾血栓形成以及MACE或死亡风险降低相关，但与移植肾排斥反应或DGF无关。未来需要开展研究评估出血风险，并最终权衡特定肾移植患者群体使用阿司匹林的总体风险和获益。
