The Johns Hopkins Bayview Vascular and Endovascular Research Center, Baltimore, MD, USA.
Am J Transplant. 2018 Jul;18(7):1718-1725. doi: 10.1111/ajt.14636. Epub 2018 Jan 24.
While studies demonstrate poor outcomes of lower extremity revascularization in patients with end-stage renal disease, little is known about results in renal transplant patients. We analyzed 2-year primary patency and limb salvage outcomes and associated risk factors of transplant (n = 202) and nontransplant patients (n = 25 274) in the Vascular Quality Initiative database undergoing infrainguinal bypass from 2003 to 2016. Multivariable Cox regression analysis and coarsened exact matching with many-to-one were used. Transplant patients were more likely to have critical limb ischemia and revascularization of more distal arteries and to receive vein conduits. Primary patency was similar between transplant and nontransplant patients at 1 year (80.8% vs 77.5%) and 2 years (67.9% vs 63.7%, P = .079). Amputation-free survival was higher for nontransplant patients (1 year: 82.4% vs 75.3%, 2 years: 68.8% vs 58.2%, P = .0060), although overall survival was equivalent (2 years: 84.6% vs 87.2%, 4 years: 75.9% vs 79.6%, P = .35). Risk factors for primary patency loss included being female, critical limb ischemia, prior bypass, and distal bypass. Age, diabetes, prior contralateral amputation, critical limb ischemia, prosthetic conduit, and more distal bypass were associated with limb loss. This is the largest series of infrainguinal revascularization in transplant patients. Outcomes for transplant patients are not inferior, and aggressive approaches at limb salvage are justifiable in appropriately selected patients.
虽然研究表明，终末期肾病患者下肢血运重建的预后较差，但对于肾移植患者的结果知之甚少。我们分析了 2003 年至 2016 年血管质量倡议数据库中 202 例接受下肢旁路手术的移植（n=202）和非移植（n=25274）患者的 2 年原发性通畅率和保肢结果及其相关危险因素。采用多变量 Cox 回归分析和粗化精确匹配（many-to-one）。移植患者更可能患有严重肢体缺血和更远处动脉的血运重建，并且更可能接受静脉移植物。1 年和 2 年时，移植患者和非移植患者的原发性通畅率相似（分别为 80.8%比 77.5%和 67.9%比 63.7%，P=0.079）。非移植患者的无截肢生存率更高（1 年：82.4%比 75.3%，2 年：68.8%比 58.2%，P=0.0060），尽管总生存率相当（2 年：84.6%比 87.2%，4 年：75.9%比 79.6%，P=0.35）。原发性通畅率丧失的危险因素包括女性、严重肢体缺血、既往旁路手术和远端旁路手术。年龄、糖尿病、对侧截肢、严重肢体缺血、假体移植物和更远处旁路手术与肢体丧失有关。这是最大的一组移植患者下肢血运重建的系列研究。移植患者的结果并不差，在适当选择的患者中，积极的保肢方法是合理的。
