Park Sehoon, Kim Young Hoon, Kim Yong Chul, Yu Mi-Yeon, Lee Jung Pyo, Han Duck Jong, Kim Yon Su, Park Su-Kil
Department of Biomedical Sciences, Seoul National University College of Medicine, Seoul, Korea.
Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
Sci Rep. 2017 Oct 23;7(1):13755. doi: 10.1038/s41598-017-13952-6.
The role of elevated post-transplant red cell distribution width (RDW) as a predictive factor for graft loss remains unclear, although RDW was reported to be significantly associated with poor prognosis in various clinical fields. We performed a retrospective cohort study with 2,939 kidney transplant patients from two tertiary teaching hospitals in Korea. RDW level at transplantation and 3-months post-transplantation were collected. Those with RDW in the upper quartile range were considered to have increased RDW (>14.9%). Death-with-graft-function (DWGF), death-censored graft failure (DCGF), and composite graft loss were assessed as the study outcomes, using multivariable cox proportional hazard model. At the median follow-up duration of 6.6 (3.6-11.4) years, 336 patients experienced graft loss. There were 679 patients with elevated RDW at 3-months post-transplant. Elevated RDW was associated with composite graft loss (adjusted hazard ratio, 1.60, 95% confidence interval, 1.23-2.07, P < 0.001), even after adjusted for hemoglobin and various clinical factors. The 1% increment of post-transplant RDW was also significantly associated with the outcome, regardless of the presence of anemia. The worst prognosis was seen in patients with elevated RDW after transplantation, but not at baseline. Therefore, post-transplant RDW level may be significantly associated with patient prognosis, independent of hemoglobin values.
尽管有报道称红细胞分布宽度（RDW）在各个临床领域与预后不良显著相关，但移植后RDW升高作为移植物丢失预测因素的作用仍不明确。我们对韩国两家三级教学医院的2939例肾移植患者进行了一项回顾性队列研究。收集了移植时和移植后3个月的RDW水平。RDW处于上四分位数范围的患者被认为RDW升高（>14.9%）。使用多变量Cox比例风险模型，将带移植物功能死亡（DWGF）、死亡截尾移植物失败（DCGF）和复合移植物丢失作为研究结局进行评估。在中位随访时间6.6（3.6 - 11.4）年时，336例患者经历了移植物丢失。移植后3个月有679例患者RDW升高。即使在对血红蛋白和各种临床因素进行校正后，RDW升高仍与复合移植物丢失相关（校正风险比为1.60，95%置信区间为1.23 - 2.07，P < 0.001）。无论是否存在贫血，移植后RDW每增加1%也与该结局显著相关。移植后RDW升高的患者预后最差，但基线时并非如此。因此，移植后RDW水平可能与患者预后显著相关，独立于血红蛋白值。
