Eum Sang Hun, Kim Da Won, Lee Jeong-Hoon, Jeon Jin Seok, Jun Heungman, Yang Jaeseok, Kim Myoung Soo, Yoon Hye Eun
Division of Nephrology, Department of Internal Medicine, Incheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Incheon 21431, Republic of Korea.
Department of Surgery, Myongji Hospital, Hanyang University, Goyang 10475, Republic of Korea.
J Clin Med. 2023 Mar 17;12(6):2337. doi: 10.3390/jcm12062337.
Little is known about the time-varying risk factors for fractures in kidney transplant recipients (KTRs). Using the Korea Organ Transplantation Registry, a nationwide cohort study of KTRs, the incidence, locations, and time-varying predictors of fractures were analyzed, including at baseline and post-transplant 6-month variables in KTRs who underwent KT between January 2014 and June 2019. Among 4134 KTRs, with a median follow-up of 2.94 years (12,441.04 person-years), 63 patients developed fractures. The cumulative 5-year incidence was 2.10%. The most frequent locations were leg (25.40%) and foot/ankle (22.22%). In multivariable analysis, older recipient age at baseline (hazard ratio [HR], 1.035; 95% confidence interval [CI], 1.007-1.064; = 0.013) and higher tacrolimus trough level (HR, 1.112; 95% CI, 1.029-1.202; = 0.029) were associated with higher risks for fractures. Pretransplant diabetes mellitus had a time-dependent impact on fractures, with increasing risk as time elapses (HR for diabetes mellitus 1.115; 95% CI, 0.439-2.832; HR for diabetes mellitus × time, 1.049; 95% CI, 1.007-1.094; = 0.022). In conclusion, KTRs had a high risk of peripheral skeletal fractures in the first 5 years. At baseline recipient age, pretransplant diabetes mellitus and tacrolimus trough level after KT were responsible for the fractures in KTRs.
关于肾移植受者（KTRs）骨折的时变风险因素，人们所知甚少。利用韩国器官移植登记处对KTRs进行的一项全国性队列研究，分析了骨折的发生率、部位以及时变预测因素，包括2014年1月至2019年6月期间接受肾移植的KTRs在基线和移植后6个月的变量。在4134名KTRs中，中位随访时间为2.94年（12441.04人年），63名患者发生了骨折。5年累积发生率为2.10%。最常见的部位是腿部（25.40%）和足/踝部（22.22%）。在多变量分析中，基线时受者年龄较大（风险比[HR]，1.035；95%置信区间[CI]，1.007 - 1.064；P = 0.013）和他克莫司谷浓度较高（HR，1.112；95% CI，1.029 - 1.202；P = 0.029）与骨折风险较高相关。移植前糖尿病对骨折有时间依赖性影响，随着时间推移风险增加（糖尿病的HR为1.115；95% CI，0.439 - 2.832；糖尿病×时间的HR为1.049；95% CI，1.007 - 1.094；P = 0.022）。总之，KTRs在最初5年内有较高的外周骨骼骨折风险。基线时受者年龄、移植前糖尿病以及肾移植后他克莫司谷浓度是导致KTRs骨折的原因。
