Okumi Masayoshi, Kakuta Yoichi, Unagami Kohei, Maenosono Ryoichi, Miyake Katsunori, Iizuka Junpei, Takagi Toshio, Ishida Hideki, Tanabe Kazunari
Department of Urology, Tokyo Women's Medical University, 8-1 Kawada-cho, Shinjuku, Tokyo, 162-8666, Japan.
Department of Nephrology, Tokyo Women's Medical University, Tokyo, Japan.
Clin Exp Nephrol. 2018 Jun;22(3):702-709. doi: 10.1007/s10157-017-1500-z. Epub 2017 Nov 20.
The number of kidney transplant recipients (KTRs) from diabetic nephropathy (DN) and with cardiovascular disease (CVD) history has increased worldwide. Nevertheless, epidemiologic evidence of CVD in KTRs remains limited.
We investigated post-transplant CVD in 1614 adult KTRs between 1990 and 2014. CVD was defined according to the international classification of diseases (ICD-10). All-cause mortality was also investigated. Final follow-up was performed in March 2016. The KTRs were categorized into four groups according to DN and CVD at surgery.
During the follow-up period, 309 KTRs experienced CVDs and 124 KTRs died. The 15-year cumulative CVDs rate was 87% in KTRs with both DN and CVD history, and the rate in KTRs without those was 22.3%. DN and CVD were associated with increased risk of post-transplant CVD [hazard ratio (HR), 3.44; 95% confidence interval (CI), 2.03-5.82; P < 0.001], and the impact marked increased after 7.5 years follow-up period (HR, 16.56; 95% CI, 6.56-41.8; P < 0.001). DN and CVD in KTRs were associated with mortality (HR, 3.32; 95% CI, 1.34-8.22; P = 0.009), and post-transplant CVD was the leading cause (35.5%) of overall death. However, DN and CVD were not associated with increased graft failure rate.
The risk of post-transplant CVDs incidence in KTRs with DN and CVD history is high, and it increases during the late transplant period. Appropriate routine cardiovascular screening and evaluation are needed to reduce late-onset CVD incidence.
在全球范围内，来自糖尿病肾病（DN）且有心血管疾病（CVD）病史的肾移植受者（KTRs）数量有所增加。然而，KTRs中CVD的流行病学证据仍然有限。
我们调查了1990年至2014年间1614名成年KTRs的移植后CVD情况。CVD根据国际疾病分类（ICD-10）进行定义。还调查了全因死亡率。最终随访于2016年3月进行。根据手术时的DN和CVD情况，将KTRs分为四组。
在随访期间，309名KTRs发生了CVD，124名KTRs死亡。有DN和CVD病史的KTRs的15年累积CVD发生率为87%，无这些情况的KTRs的发生率为22.3%。DN和CVD与移植后CVD风险增加相关[风险比（HR），3.44；95%置信区间（CI），2.03 - 5.82；P < 0.001]，且在随访7.5年后影响显著增加（HR，16.56；95% CI，6.56 - 41.8；P < 0.001）。KTRs中的DN和CVD与死亡率相关（HR，3.32；95% CI，1.34 - 8.22；P = 0.009），移植后CVD是总体死亡的主要原因（35.5%）。然而DN和CVD与移植失败率增加无关。
有DN和CVD病史的KTRs移植后发生CVD的风险很高，且在移植后期会增加。需要进行适当的常规心血管筛查和评估以降低迟发性CVD的发生率。
