Department of General, Visceral, and Transplantation Surgery, University of Heidelberg, Heidelberg, Germany.
Department of Nephrology, Heidelberg University Hospital, Heidelberg, Germany.
Eur J Vasc Endovasc Surg. 2019 Jan;57(1):139-149. doi: 10.1016/j.ejvs.2018.07.041. Epub 2018 Sep 17.
The aim of this study was to investigate the independent risk factors of vascular and haemorrhagic complications after kidney transplantation (KTx) and to evaluate how the surgeon's experience affects the rate of vascular and haemorrhagic complications.
After exclusion of paediatric and multi-organ transplantations, 1462 KTx operations between 2000 and 2016 were analysed. Independent risk factors were evaluated by multivariable logistic regression analysis. The generalised estimating equation logit model was used to display learning curve progression and determine the best cut off number of KTx operations to reduce vascular and haemorrhagic complications.
Vascular and haemorrhagic complications occurred in 38 KTx cases (2.6%). Renal vein thrombosis was the most common complication (0.6%). Graft loss occurred in 11 of 38 (28.9%) cases. Donor age of >60 years (OR 3.687, 95% CI 1.663-8.175, p = 0.001), recipient cardiovascular disease (CVD) (OR 2.270, 95% CI 1.071-4.810, p = 0.032), and surgeon's experience (OR 0.875, 95% CI 0.783-0.977, p = 0.018) were independent predictors of vascular and haemorrhagic complications. Twenty-six previous KTx operations are needed to decrease predicted probability of post-KTx vascular and haemorrhagic complications below 2.6%.
The surgeon's experience is an independent risk factor for vascular and haemorrhagic complications after KTx. Acceptable post-operative vascular and haemorrhagic complications are achieved after a minimum of 26 KTx. As a donor age of >60 years and recipient CVD are also independent risk factors for vascular and haemorrhagic complications, it is suggested that these patients should preferably be operated on by surgeons who have performed more than 26 KTx operations.
本研究旨在探讨肾移植（KTx）后血管和出血并发症的独立危险因素，并评估外科医生的经验如何影响血管和出血并发症的发生率。
排除儿科和多器官移植后，分析了 2000 年至 2016 年间的 1462 例 KTx 手术。通过多变量逻辑回归分析评估独立危险因素。广义估计方程对数模型用于显示学习曲线的进展，并确定减少血管和出血并发症的最佳 KTx 手术次数截断值。
38 例（2.6%）发生血管和出血并发症。肾静脉血栓形成是最常见的并发症（0.6%）。38 例中有 11 例（28.9%）发生移植物丢失。供体年龄>60 岁（OR 3.687，95%CI 1.663-8.175，p=0.001）、受体心血管疾病（CVD）（OR 2.270，95%CI 1.071-4.810，p=0.032）和外科医生经验（OR 0.875，95%CI 0.783-0.977，p=0.018）是血管和出血并发症的独立预测因素。需要进行 26 例以上的 KTx 手术，才能使术后 KTx 血管和出血并发症的预测概率低于 2.6%。
外科医生的经验是 KTx 后血管和出血并发症的独立危险因素。在进行 26 例以上 KTx 手术后，可获得可接受的术后血管和出血并发症。由于供体年龄>60 岁和受体 CVD 也是血管和出血并发症的独立危险因素，建议这些患者最好由进行超过 26 例 KTx 手术的外科医生进行手术。
