Kleinsteuber A, Halleck F, Khadzhynov D, Staeck A, Lehner L, Duerr M, Glander P, Schmidt D, Budde K, Staeck O
Division of Nephrology and Internal Intensive Care Medicine, Charité Universitätsmedizin Berlin, Berlin, Germany.
Division of Nephrology and Internal Intensive Care Medicine, Charité Universitätsmedizin Berlin, Berlin, Germany.
Transplant Proc. 2018 Dec;50(10):3232-3241. doi: 10.1016/j.transproceed.2018.08.028. Epub 2018 Sep 7.
Outcomes of patients with end-stage renal disease are mainly affected by their comorbidities. Detailed data evaluating the impact of pre-transplant comorbidities on long-term outcome after kidney transplantation are largely missing.
In a long-term retrospective analysis, we investigated 839 deceased donor kidney transplant recipients (KTRs) who received transplants between 1999 and 2014. The prevalence and impact of the most relevant comorbidities were studied in detail.
At the time of transplantation, 25% of KTRs had coronary artery disease (CAD), 16% had diabetes mellitus (DM), 11% had peripheral arterial disease (PAD), 8% had chronic heart failure (CHF), and 7% had cerebrovascular disease (CVD). KTRs with pre-existing CAD, DM, PAD, and CHF showed a significantly inferior patient survival. Multivariate analysis adjusting for all relevant factors and comorbidities confirmed CAD as most hazardous independent risk factor for premature death (hazard ratio [HR] 1.70; P = .002). A multivariate analysis revealed CHF and PAD as independent risk factors for death censored graft loss (HR 2.20; P = .003 and HR 1.80; P = .013). Diabetes was independently and significantly associated with T-cell- (HR 1.46; P = .020) and antibody-mediated rejections (HR 2.27; P = .030).
Detailed quantification of the impact of pre-transplant comorbidities may facilitate the evaluation of transplant candidates, guide post-transplant follow-up, and may help to further refine prediction algorithms and allocation systems.
终末期肾病患者的预后主要受其合并症影响。评估移植前合并症对肾移植后长期预后影响的详细数据大多缺失。
在一项长期回顾性分析中，我们调查了1999年至2014年间接受移植的839例 deceased donor 肾移植受者（KTRs）。详细研究了最相关合并症的患病率及其影响。
移植时，25%的KTRs患有冠状动脉疾病（CAD），16%患有糖尿病（DM），11%患有外周动脉疾病（PAD），8%患有慢性心力衰竭（CHF），7%患有脑血管疾病（CVD）。已有CAD、DM、PAD和CHF的KTRs患者生存率显著较低。对所有相关因素和合并症进行校正的多变量分析证实CAD是过早死亡最危险的独立危险因素（风险比[HR]1.70；P = 0.002）。多变量分析显示CHF和PAD是死亡截尾移植肾丢失的独立危险因素（HR 2.20；P = 0.003和HR 1.80；P = 0.013）。糖尿病与T细胞介导的排斥反应（HR 1.46；P = 0.020）和抗体介导的排斥反应（HR 2.27；P = 0.030）独立且显著相关。
对移植前合并症影响进行详细量化可能有助于评估移植候选者，指导移植后随访，并可能有助于进一步完善预测算法和分配系统。
