Division of HPB and Transplant Surgery, Department of Surgery, Erasmus MC University Medical Center, Rotterdam, The Netherlands.
Division of Nephrology, Department of Internal Medicine, Erasmus MC University Medical Center, Rotterdam, The Netherlands.
Transpl Int. 2020 May;33(5):483-496. doi: 10.1111/tri.13592. Epub 2020 Mar 4.
The prognosis of kidney transplant recipients (KTR) with vascular calcification (VC) in the aorto-iliac arteries is unclear. We performed a systematic review and meta-analysis to investigate their survival outcomes. Studies from January 1st, 2000 until March 5th, 2019 were included. Outcomes for meta-analysis were patient survival, (death-censored) graft survival and delayed graft function (DGF). Twenty-one studies were identified, eight provided data for meta-analysis. KTR with VC had a significantly increased mortality risk [1-year: risk ratio (RR) 2.19 (1.39-3.44), 5-year: RR 2.28 (1.86-2.79)]. The risk of 1-year graft loss was three times higher in recipients with VC [RR 3.15 (1.30-7.64)]. The risk of graft loss censored for death [1-year: RR 2.26 (0.58-2.73), 3-year: RR 2.19 (0.49-9.82)] and the risk of DGF (RR 1.24, 95% CI 0.98-1.58) were not statistically different. The quality of the evidence was rated as very low. To conclude, the presence of VC was associated with an increased mortality risk and risk of graft loss. In this small sample size, no statistical significant association between VC and DGF or risk of death-censored graft loss could be demonstrated. For interpretation of the outcomes, the quality and sample size of the evidence should be taken into consideration.
患有腹主动脉-髂动脉血管钙化（VC）的肾移植受者（KTR）的预后尚不清楚。我们进行了系统评价和荟萃分析，以研究其生存结果。纳入了 2000 年 1 月 1 日至 2019 年 3 月 5 日期间的研究。荟萃分析的结局包括患者生存率、（死亡校正）移植物生存率和延迟移植物功能（DGF）。确定了 21 项研究，其中 8 项提供了用于荟萃分析的数据。KTR 患有 VC 时，死亡率风险显著增加[1 年：风险比（RR）2.19（1.39-3.44），5 年：RR 2.28（1.86-2.79）]。VC 患者 1 年移植物丢失的风险增加了三倍[RR 3.15（1.30-7.64）]。考虑死亡的移植物丢失风险[1 年：RR 2.26（0.58-2.73），3 年：RR 2.19（0.49-9.82）]和 DGF 的风险[RR 1.24，95%CI 0.98-1.58]并没有统计学差异。证据质量被评为极低。总之，VC 的存在与死亡率风险和移植物丢失风险增加相关。在这个小样本量中，未能证明 VC 与 DGF 或死亡校正移植物丢失风险之间存在统计学显著关联。对于结果的解释，应考虑证据的质量和样本量。
