Wenzel Mike, Würnschimmel Christoph, Chierigo Francesco, Tian Zhe, Shariat Shahrokh F, Terrone Carlo, Saad Fred, Tilki Derya, Graefen Markus, Banek Severiné, Kluth Luis A, Mandel Philipp, Chun Felix K H, Karakiewicz Pierre I
Department of Urology, University Hospital Frankfurt, Frankfurt am Main, Frankfurt, Germany.
Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montréal Health Center, Montréal, Canada.
Prostate. 2021 Dec;81(16):1294-1302. doi: 10.1002/pros.24224. Epub 2021 Sep 13.
To analyze postoperative, in-hospital, complication rates in patients with organ transplantation before radical prostatectomy (RP).
From National Inpatient Sample (NIS) database (2000-2015) prostate cancer patients treated with RP were abstracted and stratified according to prior organ transplant versus nontransplant. Multivariable logistic regression models predicted in-hospital complications.
Of all eligible 202,419 RP patients, 216 (0.1%) underwent RP after prior organ transplantation. Transplant RP patients exhibited higher proportions of Charlson comorbidity index ≥2 (13.0% vs. 3.0%), obesity (9.3% vs. 5.6%, both p < 0.05), versus to nontransplant RP. Of transplant RP patients, 96 underwent kidney (44.4%), 44 heart (20.4%), 40 liver (18.5%), 30 (13.9%) bone marrow, <11 lung (<5%), and <11 pancreatic (<5%) transplantation before RP. Within transplant RP patients, rates of lymph node dissection ranged from 37.5% (kidney transplant) to 60.0% (bone marrow transplant, p < 0.01) versus 51% in nontransplant patients. Regarding in-hospital complications, transplant patients more frequently exhibited, diabetic (31.5% vs. 11.6%, p < 0.001), major (7.9% vs. 2.9%) cardiac complications (3.2% vs. 1.2%, p = 0.01), and acute kidney failure (5.1% vs. 0.9%, p < 0.001), versus nontransplant RP. In multivariable logistic regression models, transplant RP patients were at higher risk of acute kidney failure (odds ratio [OR]: 4.83), diabetic (OR: 2.81), major (OR: 2.39), intraoperative (OR: 2.38), cardiac (OR: 2.16), transfusion (OR: 1.37), and overall complications (1.36, all p < 0.001). No in-hospital mortalities were recorded in transplant patients after RP.
Of all transplants before RP, kidney ranks first. RP patients with prior transplantation have an increased risk of in-hospital complications. The highest risk, relative to nontransplant RP patients appears to acute kidney failure.
分析前列腺癌根治术（RP）前接受器官移植患者的术后院内并发症发生率。
从国家住院患者样本（NIS）数据库（2000 - 2015年）中提取接受RP治疗的前列腺癌患者，并根据先前是否接受器官移植分为移植组和非移植组。采用多变量逻辑回归模型预测院内并发症。
在所有符合条件的202419例RP患者中，216例（0.1%）在先前器官移植后接受了RP。与非移植RP患者相比，移植RP患者Charlson合并症指数≥2的比例更高（13.0%对3.0%），肥胖比例更高（9.3%对5.6%，均p < 0.05）。在移植RP患者中，96例接受了肾脏移植（44.4%），44例接受了心脏移植（20.4%），40例接受了肝脏移植（18.5%），30例接受了骨髓移植（13.9%），<11例接受了肺移植（<5%），<11例接受了胰腺移植（<5%）。在移植RP患者中，淋巴结清扫率从37.5%（肾脏移植）到60.0%（骨髓移植，p < 0.01）不等，而非移植患者为51%。关于院内并发症，与非移植RP患者相比，移植患者更频繁出现糖尿病（31.5%对11.6%，p < 0.001）、严重（7.9%对2.9%）心脏并发症（3.2%对1.2%，p = 0.01）和急性肾衰竭（5.1%对0.9%，p < 0.001）。在多变量逻辑回归模型中，移植RP患者发生急性肾衰竭（优势比[OR]：4.83）、糖尿病（OR：2.81）、严重（OR：2.39）、术中（OR：2.38）、心脏（OR：2.16）、输血（OR：1.37）和总体并发症（1.36，均p < 0.001）的风险更高。RP术后移植患者未记录到院内死亡病例。
在RP前的所有移植中，肾脏移植居首位。先前接受移植的RP患者院内并发症风险增加。相对于非移植RP患者，最高风险似乎是急性肾衰竭。
