Department of Renal Medicine, Sir Charles Gairdner Hospital, Perth, WA, Australia.
School of Medicine and Pharmacology, University of Western Australia, Perth, WA, Australia.
Transpl Int. 2019 Apr;32(4):387-398. doi: 10.1111/tri.13377. Epub 2018 Dec 6.
Weekend surgery may be associated with a higher risk of early complications, but the effect of the timing of kidney transplant surgery on early allograft outcome remains uncertain. The aim of this study is to evaluate whether the association between weekend transplant surgery and allograft failure was modified by prevalent vascular disease. Using data from the Australia and New Zealand Dialysis and Transplant registry, we examined the association between weekend status and 90-day and 1-year allograft failure in deceased donor transplant recipients between 1994-2012. Two-way interaction between vascular disease and weekend status was examined. Of 6622 recipients, 1868 (28.2%) received transplants during weekends. Compared with weekday transplants, weekend transplants were associated with an adjusted hazard ratio (HR) for 90-day and 1-year allograft failure of 0.99 (0.78-1.25; P = 0.917) and 0.93 (0.76-1.13, P = 0.468), respectively. There was a significant interaction between prevalent vascular disease and weekend status for 90-day allograft failure (P = 0.008) but not at 1-year, such that patients with vascular disease were more likely to experience 90-day allograft failure if transplanted on weekend (versus weekdays), particularly failures secondary to vascular complications. Timing of transplantation does not impact on allograft outcome, although those with vascular disease may benefit from more intensive post-transplant follow-up for potential vascular complications.
周末手术可能与早期并发症风险增加有关，但移植手术时间对早期移植物结果的影响仍不确定。本研究旨在评估周末进行移植手术与移植物失功之间的关联是否受到血管疾病的影响。利用澳大利亚和新西兰透析和移植登记处的数据，我们检查了 1994 年至 2012 年期间，在已故供体移植受者中周末状态与 90 天和 1 年移植物失功之间的关联。检查了血管疾病与周末状态之间的双向相互作用。在 6622 名受者中，1868 名（28.2%）在周末接受了移植。与平日移植相比，周末移植与 90 天和 1 年移植物失功的调整后的危险比（HR）分别为 0.99（0.78-1.25；P = 0.917）和 0.93（0.76-1.13，P = 0.468）。周末状态与血管疾病的共同存在对 90 天移植物失功存在显著的相互作用（P = 0.008），但在 1 年时没有相互作用，即患有血管疾病的患者如果在周末（而非平日）接受移植，则更有可能在 90 天内发生移植物失功，尤其是发生血管并发症所致的失功。移植手术的时间不会影响移植物的结果，但患有血管疾病的患者可能需要更密切的移植后随访，以预防潜在的血管并发症。
