Gramaticu A, Siriopol D, Miron A, Tacu D, Sinescu I, Gingu C, Bucsa C, Nastasa A, Covic A
University of Medicine and Pharmacy "Gr.T.Popa", Iasi, Romania.
Emergency Hospital "Elena Beldiman", Barlad, Romania.
Int Urol Nephrol. 2018 Feb;50(2):365-372. doi: 10.1007/s11255-017-1742-4. Epub 2017 Nov 17.
Kidney graft survival rates improved from decade to decade, but data about factors that affect patient and graft survival remain challenging and even controversial.
We analyzed retrospectively data from kidney transplanted patients followed in two Romanian transplant centers (Iasi and Bucharest)-new programmes specifically developed after 1989 to cover transplantation requirements for two-thirds of Romania. We used a composite survival outcome defined as 50% reduction in estimated glomerular filtration rate (eGFR), return to dialysis or death. Survival analysis was performed using uni- and multivariable Cox regression with baseline and time-updated covariates.
From the entire cohort of 365 patients, 243 had the outcome of interest. In the univariable Cox survival analysis, age, hemoglobin, eGFR, cholesterol, AST and transplant center were associated with the outcome. The multivariable Cox analysis reveals that only cholesterol (HR 0.97, 95% CI 0.94-0.99 per 10 mg/dL increase) and transplant center (HR 3.64, 95% CI 2.67-4.97) remain associated. For the time-updated Cox survival analysis we found that eGFR (HR 0.91, 95% CI 0.87-0.96 per 10 ml/min/1.73 m increase) and cholesterol are associated with the outcome in the univariable analysis and only eGFR and transplant center in the multivariable Cox survival analysis.
Our study reports data from two distinct transplant centers from a developing country. Our results are similar to the current literature data, but also reveal that the approach of a center to the transplantation management is an independent factor associated with graft survival.
肾移植的生存率逐十年提高，但有关影响患者和移植肾存活因素的数据仍具有挑战性，甚至存在争议。
我们回顾性分析了罗马尼亚两个移植中心（雅西和布加勒斯特）随访的肾移植患者的数据，这两个中心是1989年后专门为满足罗马尼亚三分之二地区的移植需求而设立的新项目。我们使用了一个复合生存结局，定义为估计肾小球滤过率（eGFR）降低50%、恢复透析或死亡。生存分析采用单变量和多变量Cox回归，并纳入基线和随时间更新的协变量。
在365例患者的整个队列中，243例出现了感兴趣的结局。在单变量Cox生存分析中，年龄、血红蛋白、eGFR、胆固醇、AST和移植中心与结局相关。多变量Cox分析显示，只有胆固醇（每增加10mg/dL，HR 0.97，95%CI 0.94 - 0.99）和移植中心（HR 3.64，95%CI 2.67 - 4.97）仍然相关。对于随时间更新的Cox生存分析，我们发现在单变量分析中eGFR（每增加10ml/min/1.73m²，HR 0.91，95%CI 0.87 - 0.96）和胆固醇与结局相关，而在多变量Cox生存分析中只有eGFR和移植中心与结局相关。
我们的研究报告了来自一个发展中国家两个不同移植中心的数据。我们的结果与当前文献数据相似，但也表明中心对移植管理的方法是与移植肾存活相关的一个独立因素。
