Department of Digestive Diseases and Transplantation, Einstein Medical Center, Philadelphia, Pennsylvania, USA,
Department of Hematology and Oncology, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA.
Cardiorenal Med. 2019;9(1):51-60. doi: 10.1159/000492731. Epub 2018 Nov 14.
Kidney transplantation (KT) is the treatment of choice for end-stage kidney disease. Cardiovascular disease is a major determinant of morbidity and mortality in patients with KT. Temporal trends in perioperative cardiovascular outcomes after KT are understudied, especially in light of an aging KT waitlist population.
We performed a retrospective observational cohort study using the National Inpatient Sample for the years 2004-2013. All adult patients undergoing KT were identified using the appropriate International Classification of Diseases, 9th Revision, Clinical Modification codes. Demographic and hospital characteristics, discharge disposition, payer status, and major adverse cardiovascular events (MACEs) were summarized using summary statistics. Multivariate logistic regression was used to identify predictors of MACEs in the perioperative period of KT.
A total of 147,431 KTs were performed between 2004 and 2013. The mean age at KT went up from 48.1 to 51.8 years from 2004 to 2013. Medicare was the primary payer for 59.6% of the KTs. Overall average perioperative mortality was 0.5%, median length of stay was 5 days, and 6.5% of patients experienced an MACE, 78% of which were heart failures (HFs). Important predictors of perioperative MACEs were age ≥65 years (OR = 2.14), Medicare as primary payer (OR = 1.51), diabetes (OR = 1.46), recreational drug use (OR = 1.72), pulmonary circulation disorders (OR = 3.28), and malnutrition (OR = 1.91).
Despite increases in age at the time of KT, the absolute risk of perioperative MACEs has remained stable from 2004 to 2013. HF is a major component of postoperative MACEs in KT. Malnutrition and pulmonary hypertension are major nontraditional predictors of perioperative MACE outcomes.
肾移植（KT）是治疗终末期肾病的首选方法。心血管疾病是 KT 患者发病率和死亡率的主要决定因素。KT 后围手术期心血管结局的时间趋势研究较少，尤其是考虑到 KT 候补名单人群老龄化。
我们使用 2004 年至 2013 年期间的国家住院患者样本进行了回顾性观察队列研究。使用适当的国际疾病分类，第 9 修订版，临床修正代码确定所有接受 KT 的成年患者。使用汇总统计数据总结人口统计学和医院特征、出院处置、支付者状态和主要不良心血管事件（MACEs）。多变量逻辑回归用于确定 KT 围手术期 MACE 的预测因素。
2004 年至 2013 年间共进行了 147431 例 KT。KT 时的平均年龄从 2004 年的 48.1 岁上升到 2013 年的 51.8 岁。医疗保险是 59.6%的 KT 的主要支付者。围手术期总死亡率平均为 0.5%，中位住院时间为 5 天，6.5%的患者发生 MACE，其中 78%为心力衰竭（HFs）。围手术期 MACE 的重要预测因素包括年龄≥65 岁（OR=2.14）、医疗保险为主要支付者（OR=1.51）、糖尿病（OR=1.46）、娱乐性药物使用（OR=1.72）、肺循环疾病（OR=3.28）和营养不良（OR=1.91）。
尽管 KT 时的年龄有所增加，但 2004 年至 2013 年期间围手术期 MACE 的绝对风险保持稳定。HF 是 KT 术后 MACE 的主要组成部分。营养不良和肺动脉高压是围手术期 MACE 结果的主要非传统预测因素。
