Richardson Cathy, Williams Aimee, McCready Jill, Khalil Khalid, Evison Felicity, Sharif Adnan
Department of Nephrology and Transplantation, Queen Elizabeth Hospital, Edgbaston, Birmingham, United Kingdom.
University of Birmingham, Birmingham, United Kingdom.
Transplant Direct. 2018 Oct 24;4(11):e402. doi: 10.1097/TXD.0000000000000836. eCollection 2018 Nov.
The aim of this study was to analyze the impact of clinic nonattendance within the first year after kidney transplantation on graft-related outcomes.
Our retrospective analysis included all patients receiving their transplant (2007-2017) and receiving their long-term follow up at our center. Clinic nonattendance was extracted from electronic patient records and informatics systems, with highest clinic nonattenders stratified at the 75th percentile.
Data were analyzed for 916 kidney allograft recipients, with median follow up 1168 days (interquartile range, 455-2073 days). Median number of missed transplant clinic visits in the first year was 5 (interquartile range, 3-7) and nonattenders were defined above the 75 percentile. Nonattenders versus attenders were more likely to be black, ABO-incompatible, repeat kidney transplant recipients but less likely to have pretransplantation diabetes. Nonattenders versus attenders had longer hospital stays after their transplant surgery in days (14.4 vs 12.2 respectively, = 0.007), higher rate of delayed graft function (21.3% vs 12.8% respectively, = 0.005), higher risk for 1-year rejection (12.5% vs 7.8% respectively, = 0.044), worse 1-year estimated glomerular filtration rate in mL/min (47.0 vs 54.1, respectively, = 0.002) and increased risk for death-censored graft loss by median follow (17.5% vs 12.0%, respectively, = 0.013). In a Cox regression model, kidney transplant recipients defined as clinic nonattenders within the first postoperative year demonstrated a significantly increased rate of death-censored graft loss (hazard ratio, 1.983; 95% confidence interval, 1.061-3.707; = 0.032).
Kidney transplant recipients in the top quartile for nonattendance require additional support and supervision to help attenuate long-term risks to their graft function and survival.
本研究旨在分析肾移植术后第一年内未就诊对移植物相关结局的影响。
我们的回顾性分析纳入了所有在我院接受移植手术（2007 - 2017年）并接受长期随访的患者。未就诊情况从电子病历和信息系统中提取，未就诊率最高的患者被分层至第75百分位数。
对916例肾移植受者的数据进行了分析，中位随访时间为1168天（四分位间距，455 - 2073天）。术后第一年错过移植门诊就诊的中位数为5次（四分位间距，3 - 7次），未就诊者定义为高于第75百分位数。与就诊者相比，未就诊者更可能为黑人、ABO血型不相容、再次肾移植受者，但移植前患糖尿病的可能性较小。未就诊者与就诊者相比，移植手术后住院天数更长（分别为14.4天和12.2天，P = 0.007），移植肾功能延迟恢复率更高（分别为21.3%和12.8%，P = 0.005），1年排斥反应风险更高（分别为12.5%和7.8%，P = 0.044），1年估计肾小球滤过率（单位：mL/min）更差（分别为47.0和54.1，P = 0.002），中位随访期内死亡删失的移植物丢失风险增加（分别为17.5%和12.0%，P = 0.013）。在Cox回归模型中，术后第一年内被定义为未就诊的肾移植受者死亡删失的移植物丢失率显著增加（风险比，1.983；95%置信区间，1.061 - 3.707；P = 0.032）。
未就诊率处于前四分位数的肾移植受者需要额外的支持和监督，以帮助降低其移植物功能和生存的长期风险。
