Bilancio G, Celano M, Cozza V, Zingone F, Palladino G, Cirillo M
Department of Medicine, Unit of Nephrology, University Hospital, Salerno, Italy.
Department "Scuola Medica Salernitana", University of Salerno, Salerno, Italy.
Transplant Proc. 2017 Nov;49(9):2092-2098. doi: 10.1016/j.transproceed.2017.09.005.
Cardiovascular disease (CVD) is frequent after kidney transplantation (KT). This study investigated CVD prediction in KT by information available before KT or within 6 months after KT. The study cohort consisted of 629 patients with KT in 2005-10 and with adult age at KT. The end point was incidence up to 2015 of CVD (coronary heart disease, cerebrovascular disease, peripheral artery disease). Graft failure, non-CVD death with functioning graft, and loss to follow-up were considered competing events. CVD prediction was investigated for 34 variables by means of competing-risks regression. Follow-up range was 0.28-10.00 years (mean ± SD, 7.30 ± 3.10). First incident event was CVD in 103 patients and competing events in 146 patients. In the multivariable model for pre-KT variables only, CVD predictors were male sex (hazard ratio [HR], 1.68; 95% confidence interval [CI], 1.06-2.66), diabetic nephropathy (HR, 6.63; 95% CI, 1.81-24.35), pre-KT dialysis for ≥5 years (HR, 1.52; 95% CI, 1.02-2.27), pre-KT CVD (HR, 4.87; 95% CI, 2.84-8.35), and age at KT ≥45 years (HR, 2.98; 95% CI, 1.83-4.87). In the model for pre-KT and post-KT variables together, the sole post-KT CVD predictor was estimated glomerular filtration rate <60 mL/min at the 6-month visit (HR, 1.75; 95% CI, 1.11-2.77). Diabetic nephropathy, pre-KT dialysis, pre-KT CVD, and age at KT predicted 91.2% of incident CVD. Early available information effectively predicted CVD in KT independently from competing events.
心血管疾病（CVD）在肾移植（KT）后很常见。本研究通过肾移植前或肾移植后6个月内可获得的信息来调查肾移植受者的心血管疾病预测情况。研究队列包括2005年至2010年接受肾移植且肾移植时已成年的629例患者。终点为截至2015年心血管疾病（冠心病、脑血管疾病、外周动脉疾病）的发病率。移植失败、移植功能正常时的非心血管疾病死亡以及失访被视为竞争事件。通过竞争风险回归对34个变量进行心血管疾病预测研究。随访时间范围为0.28至10.00年（均值±标准差，7.30±3.10）。103例患者首次发生的事件为心血管疾病，146例患者为竞争事件。仅在肾移植前变量的多变量模型中，心血管疾病的预测因素为男性（风险比[HR]，1.68；95%置信区间[CI]，1.06 - 2.66）、糖尿病肾病（HR，6.63；95%CI，1.81 - 24.35）、肾移植前透析≥5年（HR，1.52；95%CI，1.02 - 2.27）、肾移植前心血管疾病（HR，4.87；95%CI，2.84 - 8.35）以及肾移植时年龄≥45岁（HR，2.98；95%CI，1.83 - 4.87）。在肾移植前和肾移植后变量共同的模型中，肾移植后唯一的心血管疾病预测因素是6个月随访时估计肾小球滤过率<60 mL/min（HR，1.75；95%CI，1.11 - 2.77）。糖尿病肾病、肾移植前透析、肾移植前心血管疾病以及肾移植时年龄可预测91.2%的心血管疾病发病情况。早期可获得的信息能够独立于竞争事件有效地预测肾移植受者的心血管疾病。
