Renal Transplant Unit, Hospital Israelita Albert Einstein, São Paulo, Brazil.
Nephrology Division, Federal University of São Paulo, São Paulo, Brazil.
PLoS One. 2021 Jan 20;16(1):e0245628. doi: 10.1371/journal.pone.0245628. eCollection 2021.
Returning to dialysis after kidney graft loss (GL) is associated with a high risk of mortality, mainly in the first 3-6 months. The follow-up of patients with GL should be extended to better understand crude patient outcomes, mainly in emerging countries, where the transplantation activity has increased.
This is a historical single-center cohort study conducted in an emerging country (Brazil) that included 115 transplant patients with kidney allograft failure who were followed for 44.1 (21.4; 72.6) months after GL. The outcomes were death or retransplantation after GL calculated by Kaplan-Meier and log-rank tests. Proportional hazard ratios for death and retransplantation were assessed by Cox regression.
The 5-year probability of retransplantation was 38.7% (95% CI: 26.1%-51.2%) and that of death was 37.7% (95% CI: 24.9%-50.5%); OR = 1.03 (95% CI: 0.71-1.70) and P = 0.66. The likelihood of retransplantation was higher in patients who resumed dialysis with higher levels of hemoglobin (HR = 1.22; 95% CI = 1.04-1.43; P = 0.01) and lower in blood type O patients (HR = 0.48; 95% CI = 0.25-0.93; P = 0.03), which was associated with a lower frequency of retransplantation with a subsequent living-donor kidney. On the other hand, the risk of death was significantly associated with Charlson comorbidity index (HR for each point = 1.37; 95% CI 1.19-1.50; P<0.001), and residual eGFR at the time when patients had resumed to dialysis (HR for each mL = 1.14; 95% CI = 1.05-1.25; P = 0.002). The trend toward a lower risk of death when patients had resumed to dialysis using AV fistula access was observed (HR = 0.50; 95% CI 0.25-1.02; P = 0.06), while a higher risk seems to be associated with the number of previous engraftment (HR = 2.01; 95% CI 0.99-4.07; P = 0.05).
The 5-year probability of retransplantation was not less than that of death. Variables related to the probability of retransplantation were hemoglobin level before resuming dialysis and ABO blood type, while the risk of death was associated with comorbidities and residual eGFR.
肾移植后（GL）失功后重新开始透析与高死亡率相关，主要发生在 3-6 个月内。GL 患者的随访应延长，以更好地了解主要发生在新兴国家的患者的总体结局，这些国家的移植活动有所增加。
这是一项在新兴国家（巴西）进行的单中心历史队列研究，纳入了 115 名因肾移植失败而进行透析的患者，对他们 GL 后 44.1（21.4；72.6）个月的结局进行随访。使用 Kaplan-Meier 和对数秩检验计算 GL 后死亡或再次移植的发生率。通过 Cox 回归评估死亡和再次移植的比例风险比。
5 年再次移植的概率为 38.7%（95%CI：26.1%-51.2%），死亡概率为 37.7%（95%CI：24.9%-50.5%）；OR=1.03（95%CI：0.71-1.70），P=0.66。开始透析时血红蛋白水平较高的患者再次移植的可能性更高（HR=1.22；95%CI=1.04-1.43；P=0.01），而 O 型血患者再次移植的可能性更低（HR=0.48；95%CI=0.25-0.93；P=0.03），这与随后使用活体供者肾进行再次移植的频率较低有关。另一方面，死亡风险与 Charlson 合并症指数显著相关（每增加 1 分的 HR=1.37；95%CI 1.19-1.50；P<0.001），以及患者重新开始透析时的残余 eGFR（每增加 1ml 的 HR=1.14；95%CI=1.05-1.25；P=0.002）。开始透析时使用动静脉瘘通路与较低的死亡风险有关（HR=0.50；95%CI 0.25-1.02；P=0.06），而更多的移植次数似乎与更高的风险相关（HR=2.01；95%CI 0.99-4.07；P=0.05）。
5 年再次移植的概率不低于死亡概率。与再次移植概率相关的变量是开始透析前的血红蛋白水平和 ABO 血型，而死亡风险与合并症和残余 eGFR 相关。
