Sheshadri Anoop, Cullaro Giuseppe, Johansen Kirsten L, Lai Jennifer C
Division of Nephrology, Department of Medicine, University of California, San Francisco, California, USA.
San Francisco Veterans Affairs Medical Center, San Francisco, California, USA.
Clin Transplant. 2020 Jun;34(6):e13848. doi: 10.1111/ctr.13848. Epub 2020 Apr 3.
Patients with end-stage renal disease (ESRD) have impaired functional status compared with the general population. We sought to explore the association between Karnofsky Performance Status (KPS) and death/delisting from the kidney transplantation waitlist and whether this association differed by age. Patients listed for single-organ kidney transplantation in the United Network for Organ Sharing/Organ Procurement and Transplantation Network from January 1, 2015, to January 1, 2018, were included. We performed competing-risk regression analyses to determine the association between KPS ("Severely impaired", "Moderately impaired", "Non-impaired") and death/delisting, with deceased-donor kidney transplantation as a competing risk. We tested for interactions between age and KPS on death/delisting. Of the 89,819 patients analyzed, 39% were impaired (KPS < 80) and 20% were aged ≥ 65 years. Older age and lower KPS were independently associated with higher risk of death/delisting (age 45-64 years, HR 1.97 [95% CI 1.73-2.24]; age ≥ 65 years, HR 3.62 [95% CI 3.33-3.92] compared with age < 45 years; moderately impaired, HR 1.68 [95% CI 1.45-1.95]; severely impaired, HR 4.80 [95% CI 3.71-6.21] compared with non-impaired). Lower KPS was associated with higher risk of death/delisting among all ages, but this effect was slightly less pronounced among individuals aged ≥ 65 years. Performance status should be used when counseling patients with ESRD on their risks for death/delisting.
与普通人群相比，终末期肾病（ESRD）患者的功能状态受损。我们试图探讨卡诺夫斯基性能状态（KPS）与肾脏移植等待名单上的死亡/退出之间的关联，以及这种关联是否因年龄而异。纳入了2015年1月1日至2018年1月1日期间在器官共享联合网络/器官获取与移植网络中登记进行单器官肾脏移植的患者。我们进行了竞争风险回归分析，以确定KPS（“严重受损”、“中度受损”、“未受损”）与死亡/退出之间的关联，将已故供体肾脏移植作为竞争风险。我们测试了年龄和KPS在死亡/退出方面的相互作用。在分析的89819名患者中，39%有功能受损（KPS<80），20%年龄≥65岁。年龄较大和KPS较低与死亡/退出的较高风险独立相关（45-64岁，HR 1.97[95%CI 1.73-2.24]；≥65岁，HR 3.62[95%CI 3.33-3.92]，与<45岁相比；中度受损，HR 1.68[95%CI 1.45-1.95]；严重受损，HR 4.80[95%CI 3.71-6.21]，与未受损相比）。较低的KPS与所有年龄段死亡/退出的较高风险相关，但在≥65岁的个体中这种影响略不明显。在为ESRD患者提供关于死亡/退出风险的咨询时，应考虑性能状态。
