中心体积与肾移植中选定高危人群移植结局的相关性。
The association of center volume with transplant outcomes in selected high-risk groups in kidney transplantation.
机构信息
Division of Nephrology, Washington University School of Medicine, 4523 Clayton Ave. CB 8126, St. Louis, MO, 63110, USA.
Division of Public Health Sciences, Department of Surgery, Washington University School of Medicine, St. Louis, MO, USA.
出版信息
BMC Nephrol. 2023 Mar 20;24(1):61. doi: 10.1186/s12882-023-03099-0.
BACKGROUND
In context of increasing complexity and risk of deceased kidney donors and transplant recipients, the impact of center volume (CV) on the outcomes of high-risk kidney transplants(KT) has not been well determined.
METHODS
We examined the association of CV and outcomes among 285 U.S. transplant centers from 2000-2016. High-risk KT were defined as recipient age ≥ 70 years, body mass index (BMI) ≥ 35 kg/m, receiving kidneys from donors with kidney donor profile index(KDPI) ≥ 85%, acute kidney injury(AKI), hepatitisC + . Average annual CV for the specific-high-risk KT categorized in tertiles. Death-Censored-Graft-Loss(DCGL) and death at 3 months, 1, 5, and 10 years were compared between CV tertiles using Cox-regression models.
RESULTS
Two hundred fifty thousand five hundred seventy-four KT were analyzed. Compared to high CV, recipients with BMI ≥ 35 kg/m had higher risk of DCGL in low CV(aHR = 1.11,95%CI = 1.03-1.19) at 10 years; recipients with age ≥ 70 years had higher risk of death in low CV(aHR = 1.07,95%CI = 1.01-14) at 10 years. There was no difference of DCGL or death in low CV for donors with KDPI ≥ 85%, hepatitisC + , or AKI.
CONCLUSIONS
Recipients of high-risk KT with BMI ≥ 35 kg/m have higher risk of DCGL and recipients age ≥ 70 years have higher risk of death in low CV, compared to high CV. Future studies should identify care practices associated with CV that support optimal outcomes after KT.
背景
在供体死亡风险和受体风险增加的情况下，中心容量（CV）对高危肾脏移植（KT）结局的影响尚未得到很好的确定。
方法
我们研究了 2000 年至 2016 年间 285 家美国移植中心的 CV 和结局之间的关联。高危 KT 定义为受体年龄≥70 岁、体重指数（BMI）≥35kg/m、接受 KDPI≥85%的供体肾脏、急性肾损伤（AKI）、丙型肝炎阳性。将特定高危 KT 按三分位数进行分类，计算其平均年 CV。使用 Cox 回归模型比较 CV 三分位数之间的死亡风险校正移植物丢失（DCGL）和 3 个月、1 年、5 年和 10 年的死亡率。
结果
分析了 250574 例 KT。与高 CV 相比，BMI≥35kg/m 的受体在低 CV 中的 DCGL 风险更高（aHR=1.11，95%CI=1.03-1.19），10 年时；年龄≥70 岁的受体在低 CV 中死亡的风险更高（aHR=1.07，95%CI=1.01-14），10 年时。KDPI≥85%、丙型肝炎阳性或 AKI 的供体在低 CV 中，DCGL 或死亡无差异。
结论
与高 CV 相比，BMI≥35kg/m 的高危 KT 受体的 DCGL 风险更高，年龄≥70 岁的受体在低 CV 中的死亡风险更高。未来的研究应确定与 CV 相关的护理实践，以支持 KT 后的最佳结果。
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