Min Hyeon-Jin, Park Jung-Soo, Yang Jaeseok, Yang Jihyun, Oh Se Won, Jo Sang-Kyung, Cho Won Yong, Gwon Jun Gyo, Jung Cheol Woong, Seol Yang-Jo, Park Shin-Young, Kim Myung-Gyu
Division of Nephrology, Department of Internal Medicine, Korea University Anam Hospital, Seoul, Republic of Korea.
Department of Periodontology, Korea University Anam Hospital, Seoul, Republic of Korea.
Kidney Res Clin Pract. 2022 Jan;41(1):114-123. doi: 10.23876/j.krcp.21.097. Epub 2022 Jan 24.
Recent several reports have demonstrated that periodontitis is prevalent and adversely affects the survival in patients with chronic kidney disease (CKD) or end-stage kidney disease. However, its impact on transplant outcomes remains uncertain.
This retrospective cohort study included 136 and 167 patients, respectively, who underwent living donor kidney transplantation (KT) at Seoul National University Hospital from July 2012 to August 2016 and Korea University Hospital from April 2008 to October 2018. We divided patients into three groups according to stages of periodontitis based on a new classification system.
Patients with severe periodontitis were older, had a higher prevalence of diabetes, a higher body mass index and C-reactive protein level, a lower cardiac output, and were more likely to be smokers, indicating its association with chronic systemic inflammation. After KT, stage IV periodontitis was independently associated with a lower incidence of acute T cell-mediated rejection, suggesting the possible effect of periodontitis on immune function. However, 1-year and 3-year estimated glomerular filtration rates were not different. Among the KT recipients followed up more than 3 years, new-onset cardiovascular disease occurred in nine patients, and coronary artery disease occurred more frequently in patients with stage IV periodontitis. However, diabetes was the independent predictor of new-onset coronary artery disease in multivariate logistic regression analysis.
Our findings showed that periodontitis might be an important player in determining posttransplant outcomes in recipients. Further interventional trials to test whether treating periodontitis could modify transplant outcome are needed.
最近的几份报告表明，牙周炎很常见，并且会对慢性肾脏病（CKD）或终末期肾病患者的生存率产生不利影响。然而，其对移植结果的影响仍不确定。
这项回顾性队列研究分别纳入了136例和167例患者，他们于2012年7月至2016年8月在首尔国立大学医院以及2008年4月至2018年10月在韩国大学医院接受了活体供肾移植（KT）。我们根据一种新的分类系统，将患者按照牙周炎的阶段分为三组。
重度牙周炎患者年龄更大，糖尿病患病率更高，体重指数和C反应蛋白水平更高，心输出量更低，且更有可能是吸烟者，这表明其与慢性全身炎症有关。KT后，IV期牙周炎与急性T细胞介导的排斥反应发生率较低独立相关，提示牙周炎可能对免疫功能有影响。然而，1年和3年的估计肾小球滤过率并无差异。在随访超过3年的KT受者中，9例出现了新发心血管疾病，IV期牙周炎患者中冠心病的发生率更高。然而，在多因素逻辑回归分析中，糖尿病是新发冠心病的独立预测因素。
我们的研究结果表明，牙周炎可能是决定受者移植后结果的一个重要因素。需要进一步的干预试验来检验治疗牙周炎是否可以改善移植结果。
