在阿根廷一家转诊中心，作为肾移植病因的志贺毒素相关溶血性尿毒症综合征发病率下降。
A decrease in the incidence of Shiga toxin-related hemolytic uremic syndrome as a cause of kidney transplantation at an argentine referral center.
作者信息
Monteverde Marta L, Panero Natalia, Chaparro Alicia B, Locane Fabrizio, Sarkis Claudia, Mattio Silvana A, Ibañez Juan P
机构信息
Nephrology Department, Renal Transplant Unit, Hospital de Pediatria J.P Garrahan, Buenos Aires, Argentina.
Infectology and Epidemiology Department, Hospital de Pediatria J.P Garrahan, CABA, Argentina.
出版信息
Pediatr Transplant. 2023 Jun;27(4):e14489. doi: 10.1111/petr.14489. Epub 2023 Mar 1.
BACKGROUND
In Argentina, Hemolytic uremic syndrome caused by Shiga toxin-producing Escherichia coli (STEC HUS), is the main cause of acute kidney injury and the second cause of end-stage renal disease (ESRD) in children. In recent decades, strategies have been implemented to reduce progression to ESRD, but it is not known whether the cumulative incidence of HUS requiring kidney transplantation (KTx) has decreased. We aimed to determine whether the cumulative incidence of STEC HUS in children undergoing KTx decreased and compared outcomes of HUS-related KTx vs. those related to other etiologies.
METHODS
All patients who underwent KTx at our institution were evaluated. The cohort was divided into quintiles (Q), and we compared the cumulative incidence of HUS-related KTx vs KTx due to other etiologies.
RESULTS
A total of 1000 consecutive KTx were included. The cumulative incidence of HUS-related KTx was 11%. HUS was the second cause of KTx in Q1: 17% (1988-1995); Q2: 13.5% (1996-2003); Q3: 11.5% (2004-2009) and third cause in Q4: 10% (2010-2015) and Q5: 3% (2016-2021). The cumulative incidence of HUS-related KTx decreased in Q4 and Q5 compared to Q1, Q2, and Q3 and the decline was even steeper when comparing Q4 to Q5 (p:0.019). There was no difference in graft survival in patients with HUS vs. congenital anomalies of kidney and urinary tract (CAKUT) but better than in those with focal segmental glomerulosclerosis (FSGS).
CONCLUSIONS
In this cohort, the cumulative incidence of HUS-related KTx decreased, which may have been due to the implementation of nephroprotective strategies.
背景
在阿根廷，由产志贺毒素大肠杆菌（STEC HUS）引起的溶血性尿毒症综合征是儿童急性肾损伤的主要原因，也是终末期肾病（ESRD）的第二大原因。近几十年来，已实施了多种策略以减少ESRD的进展，但尚不清楚需要肾移植（KTx）的溶血性尿毒症综合征的累积发病率是否有所下降。我们旨在确定接受KTx的儿童中STEC HUS的累积发病率是否降低，并比较溶血性尿毒症综合征相关KTx与其他病因相关KTx的结局。
方法
对在我们机构接受KTx的所有患者进行评估。将队列分为五分位数（Q），并比较溶血性尿毒症综合征相关KTx与其他病因导致的KTx的累积发病率。
结果
共纳入1000例连续的KTx病例。溶血性尿毒症综合征相关KTx的累积发病率为11%。溶血性尿毒症综合征是第一五分位数（Q1：1988 - 1995年）中KTx的第二大原因：17%；第二五分位数（Q2：1996 - 2003年）：13.5%；第三五分位数（Q3：2004 - 2009年）：11.5%；第四五分位数（Q4：2010 - 2015年）中的第三大原因：10%；第五五分位数（Q5：2016 - 2021年）：3%。与Q1、Q2和Q3相比，Q4和Q5中溶血性尿毒症综合征相关KTx的累积发病率降低，并且将Q4与Q5比较时下降更为明显（p：0.019）。溶血性尿毒症综合征患者与肾和尿路先天性异常（CAKUT）患者的移植物存活率无差异，但优于局灶节段性肾小球硬化（FSGS）患者。
结论
在该队列中，溶血性尿毒症综合征相关KTx的累积发病率降低，这可能归因于肾保护策略的实施。
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