Centre for Transplant and Renal Research, Westmead Hospital, Sydney, Australia.
Renal Department, Royal Prince Alfred Hospital, Sydney, Australia.
Transplantation. 2021 Feb 1;105(2):413-422. doi: 10.1097/TP.0000000000003224.
Transplant recipients experience excess cardiac mortality. We compared circulatory death rates in Australian and New Zealand kidney transplant recipients to the general population and identified risk factors for circulatory death in kidney transplant recipients.
The primary cause of death for kidney transplant recipients aged ≥18 was established through ICD-10-AM codes using data linkage between the Australia and New Zealand dialysis and transplant registry and national death registers. We estimated standardized mortality ratios (SMRs) and developed a Fine-Gray competing risks model to determine risk factors for cardiac mortality.
Of 5089 deaths in 16 329 kidney transplant recipients (158 325 person-years), 918 (18%) were cardiac. An increased risk of circulatory death was associated with older age (P < 0.001), male sex (P < 0.001), longer dialysis duration (P = 0.004), earlier era of transplantation (P < 0.001), ever graft failure (P < 0.001), known coronary artery disease (P = 0.002), and kidney failure from diabetes or hypertension (P < 0.001). The cardiac SMR was 5.4 [95% confidence interval (CI): 5.0-5.8], falling from 8.0 (95% CI: 4.9-13.1) in 1988 to 5.3 (95% CI: 4.0-7.0) in 2013 (P < 0.001). Females, particularly young ones, had significantly higher relative cardiac mortality than men. In recipients aged 40 years, the cardiac SMR was 26.5 (95% CI: 15.0-46.6) in females and 7.5 (95% CI: 5.0-11.1) for males.
Cardiac risks remain elevated in kidney transplant recipients and may be under-recognized, and prevention and treatment interventions less accessed, less effective or even harmful in female recipients.
移植受者的心脏死亡率过高。我们比较了澳大利亚和新西兰肾移植受者与普通人群的循环死亡率，并确定了肾移植受者循环死亡的危险因素。
通过澳大利亚和新西兰透析和移植登记处与国家死亡登记处之间的数据链接，根据 ICD-10-AM 代码确定年龄≥18 岁的肾移植受者的主要死因。我们估计了标准化死亡率比（SMR），并开发了 Fine-Gray 竞争风险模型来确定心脏死亡率的危险因素。
在 16329 例肾移植受者（158325 人年）中，有 5089 例死亡（18%），其中 918 例（18%）为心脏性。循环死亡风险增加与年龄较大（P<0.001）、男性（P<0.001）、透析时间较长（P=0.004）、移植时代较早（P<0.001）、既往移植物衰竭（P<0.001）、已知冠状动脉疾病（P=0.002）和糖尿病或高血压引起的肾衰竭有关。心脏 SMR 为 5.4[95%置信区间（CI）：5.0-5.8]，从 1988 年的 8.0（95%CI：4.9-13.1）下降到 2013 年的 5.3（95%CI：4.0-7.0）（P<0.001）。女性，特别是年轻女性，心脏相对死亡率明显高于男性。在 40 岁的受者中，女性的心脏 SMR 为 26.5（95%CI：15.0-46.6），男性为 7.5（95%CI：5.0-11.1）。
肾移植受者的心脏风险仍然较高，可能被低估，预防和治疗干预措施在女性受者中较少被采用，效果较差，甚至有害。
