高血压活体肾供体肾移植受者的长期肾功能及生存情况:一项全国队列研究

Long-term kidney function and survival in recipients of allografts from living kidney donors with hypertension: a national cohort study.

作者信息

Al Ammary Fawaz, Yu Sile, Muzaale Abimereki D, Segev Dorry L, Liyanage Luckmini, Crews Deidra C, Brennan Daniel C, El-Meanawy Ashraf, Alqahtani Saleh, Atta Mohamed G, Levan Macey L, Caffo Brian S, Welling Paul A, Massie Allan B

机构信息

Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA.

Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA.

出版信息

Transpl Int. 2021 Aug;34(8):1530-1541. doi: 10.1111/tri.13947. Epub 2021 Jul 8.

Abstract

Allografts from living kidney donors with hypertension may carry subclinical kidney disease from the donor to the recipient and, thus, lead to adverse recipient outcomes. We examined eGFR trajectories and all-cause allograft failure in recipients from donors with versus without hypertension, using mixed-linear and Cox regression models stratified by donor age. We studied a US cohort from 1/1/2005 to 6/30/2017; 49 990 recipients of allografts from younger (<50 years old) donors including 597 with donor hypertension and 21 130 recipients of allografts from older (≥50 years old) donors including 1441 with donor hypertension. Donor hypertension was defined as documented predonation use of antihypertensive therapy. Among recipients from younger donors with versus without hypertension, the annual eGFR decline was -1.03 versus -0.53 ml/min/m (P = 0.002); 13-year allograft survival was 49.7% vs. 59.0% (adjusted allograft failure hazard ratio [aHR] 1.23; 95% CI 1.05-1.43; P = 0.009). Among recipients from older donors with versus without hypertension, the annual eGFR decline was -0.67 versus -0.66 ml/min/m (P = 0.9); 13-year allograft survival was 48.6% versus 52.6% (aHR 1.05; 95% CI 0.94-1.17; P = 0.4). In secondary analyses, our inferences remained similar for risk of death-censored allograft failure and mortality. Hypertension in younger, but not older, living kidney donors is associated with worse recipient outcomes.

摘要

来自患有高血压的活体肾供体的同种异体移植物可能会将供体的亚临床肾病传递给受体,从而导致受体出现不良结局。我们使用按供体年龄分层的混合线性和Cox回归模型,研究了有高血压与无高血压供体的受体的估算肾小球滤过率(eGFR)轨迹和全因移植物失败情况。我们研究了2005年1月1日至2017年6月30日的一个美国队列;49990名来自年轻(<50岁)供体的同种异体移植物受体,其中包括597名有供体高血压的受体,以及21130名来自年长(≥50岁)供体的同种异体移植物受体,其中包括1441名有供体高血压的受体。供体高血压定义为捐赠前有使用抗高血压治疗的记录。在来自年轻供体且有高血压与无高血压的受体中,eGFR的年下降率分别为-1.03与-0.53 ml/min/m²(P = 0.002);13年移植物存活率分别为49.7%与59.0%(调整后的移植物失败风险比[aHR]为1.23;95%置信区间为1.05 - 1.43;P = 0.009)。在来自年长供体且有高血压与无高血压的受体中,eGFR的年下降率分别为-0.67与-0.66 ml/min/m²(P = 0.9);13年移植物存活率分别为48.6%与52.6%(aHR为1.05;95%置信区间为0.94 - 1.17;P = 0.4)。在二次分析中,我们对死亡删失的移植物失败风险和死亡率的推断仍然相似。年轻但不是年长的活体肾供体的高血压与受体的更差结局相关。

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