Division of Nephrology, Taichung Veterans General Hospital, Taichung 407, Taiwan.
Graduate Institute of Public Health, China Medical University, Taichung 404, Taiwan.
Int J Environ Res Public Health. 2019 Jan 24;16(3):326. doi: 10.3390/ijerph16030326.
: The incidence of stroke after kidney transplantation is poorly understood. Our study aimed to determine the incidence and predictors of stroke as well as mortality from stroke in kidney transplant recipients (KTRs). : This retrospective cohort study used the National Health Insurance Research Database in Taiwan to study KTRs ( = 4635), patients with end-stage renal disease (ESRD; = 69,297), and patients from the general population who were chronic kidney disease (CKD)-free and matched by comorbidities ( = 69,297) for the years 2000 through 2010. The risk of stroke was analyzed using univariate and multivariate Cox regression models and compared between study cohorts. : Compared with the ESRD subgroup, KTRs had a significantly lower risk of overall stroke (adjusted hazard ratio (aHR) = 0.37, 95% confidence interval (CI) = 0.31⁻0.44), ischemic stroke (aHR = 0.45, 95% CI = 0.37⁻0.55), and hemorrhagic stroke (aHR = 0.20, 95% CI = 0.14⁻0.29). The risk patterns for each type of stroke in the KTR group were not significantly different than those of the CKD-free control subgroup. The predictors of stroke were age and diabetes in KTRs. All forms of stroke after transplantation independently predicted an increased risk of subsequent mortality, and the strongest risk was related to hemorrhagic events. : KTRs had a lower risk of stroke than ESRD patients, but this risk was not significantly different from that of the CKD-free comorbidities-matched general population group. Although stroke was relatively uncommon among cardiovascular events, it predicted unfavorable outcome in KTRs.
：肾移植后中风的发病率尚不清楚。本研究旨在确定中风的发生率和预测因素，以及肾移植受者（KTR）的中风死亡率。：本回顾性队列研究使用台湾全民健康保险研究数据库，研究了 2000 年至 2010 年间的 4635 名 KTR、69297 名终末期肾病（ESRD）患者和 69297 名无慢性肾脏病（CKD）且伴有并发症的普通人群患者。采用单变量和多变量 Cox 回归模型分析中风风险，并比较研究队列之间的风险。：与 ESRD 亚组相比，KTR 总体中风（校正风险比（aHR）=0.37，95%置信区间（CI）=0.31⁻0.44）、缺血性中风（aHR=0.45，95%CI=0.37⁻0.55）和出血性中风（aHR=0.20，95%CI=0.14⁻0.29）的风险明显降低。KTR 组每种类型中风的风险模式与无 CKD 对照组亚组无显著差异。KTR 中风的预测因素是年龄和糖尿病。移植后所有类型的中风均独立预测随后死亡率增加，风险最强与出血事件相关。：KTR 中风风险低于 ESRD 患者，但与无 CKD 伴并发症匹配的普通人群组相比，风险无显著差异。尽管中风在心血管事件中相对少见，但它预测了 KTR 的不良结局。
