Department of Renal Medicine, Sir Charles Gairdner Hospital, Perth, WA, Australia.
Centre for Transplant and Renal Research, Westmead Hospital, Sydney, NSW, Australia.
Transpl Int. 2019 Dec;32(12):1247-1258. doi: 10.1111/tri.13492. Epub 2019 Oct 1.
Nonadherence is an important risk factor for premature allograft failure after kidney transplantation, but outcomes after re-transplantation remain uncertain. Using data from the Australian and New Zealand Dialysis and Transplant registry, the associations between causes of first allograft failure and acute rejection-related and non-adherence-related allograft failure following re-transplantation were examined using competing risk analyses, treating the respective alternative causes of allograft failure and death with functioning graft as competing events. Fifty-nine of 2450 patients (2%) lost their first allografts from nonadherence. Patients who lost their first kidney allograft from nonadherence were younger at the time of first kidney allograft failure but waited longer for a second allograft (>5 years: 54% vs. 20%, P < 0.001) compared with other causes. Compared with patients who lost their first allograft from causes other than nonadherence, the adjusted subdistribution hazard ratio (HR and 95% CI) for acute rejection-related second allograft failure was 0.58 (0.08, 4.07; P = 0.582) for patients with allograft failure attributed to nonadherence and was 6.30 (1.34, 29.67; P = 0.020) for non-adherence-related second allograft failure. In this cohort of transplant recipients who have received second allografts, first allograft failure secondary to nonadherence was associated with a marginally greater risk of allograft failure attributed to nonadherence in subsequent transplantation.
不遵医嘱是肾移植后移植物早期失功的一个重要危险因素，但再次移植后的结局仍不确定。利用澳大利亚和新西兰透析和移植登记处的数据，通过竞争风险分析，研究了首次移植物失功的原因与再次移植后与急性排斥反应相关的和与不遵医嘱相关的移植物失功之间的关联，将各自导致移植物失功的其他原因和有功能移植物的死亡视为竞争事件。在 2450 例患者中，有 59 例（2%）因不遵医嘱而失去了首次移植物。首次因不遵医嘱而失去肾移植物的患者首次肾移植物失功时年龄较小，但等待第二次移植的时间较长（>5 年：54%比 20%，P<0.001）。与首次因不遵医嘱以外的原因而失去移植物的患者相比，调整后的亚分布危险比（HR 和 95%CI）显示，急性排斥反应相关的第二次移植物失功的风险在归因于不遵医嘱的患者中为 0.58（0.08，4.07；P=0.582），在与不遵医嘱相关的第二次移植物失功的患者中为 6.30（1.34，29.67；P=0.020）。在接受第二次移植的这批移植受者中，首次因不遵医嘱而导致的移植物失功与随后移植中归因于不遵医嘱的移植物失功风险略有增加相关。
