Lam Ngan N, Quinn Robert R, Clarke Alix, Al-Wahsh Huda, Knoll Greg A, Tibbles Lee Anne, Kamar Fareed, Jeong Rachel, Kiberd James, Ravani Pietro
Division of Nephrology, Cumming School of Medicine, University of Calgary, AB, Canada.
Department of Community Health Sciences, University of Calgary, AB, Canada.
Can J Kidney Health Dis. 2023 Jun 1;10:20543581231177203. doi: 10.1177/20543581231177203. eCollection 2023.
Few studies have assessed outcomes in transplant recipients with failing grafts as most studies have focused on outcomes after graft loss.
To determine whether renal function declines faster in kidney transplant recipients with a failing graft than in people with chronic kidney disease of their native kidneys.
Retrospective cohort study.
Alberta, Canada (2002-2019).
We identified kidney transplant recipients with a failing graft (2 estimated glomerular filtration rate [eGFR] measurements 15-30 mL/min/1.73 m ≥90 days apart).
We compared the change in eGFR over time (eGFR with 95% confidence limits, eGFR) and the competing risks of kidney failure and death (cause-specific hazard ratios [HRs], HR).
Recipients (n = 575) were compared with propensity-score-matched, nontransplant controls (n = 575) with a similar degree of kidney dysfunction.
The median potential follow-up time was 7.8 years (interquartile range, 3.6-12.1). The hazards for kidney failure (HR1.33) and death (HR1.59) were significantly higher for recipients, while the eGFR decline over time was similar (recipients vs controls: -2.27 vs -2.21 mL/min/1.73 m per year). The rate of eGFR decline was associated with kidney failure but not death.
This was a retrospective, observational study, and there is a risk of bias due to residual confounding.
Although eGFR declines at a similar rate in transplant recipients as in nontransplant controls, recipients have a higher risk of kidney failure and death. Studies are needed to identify preventive measures to improve outcomes in transplant recipients with a failing graft.
由于大多数研究集中在移植肾丢失后的结局，很少有研究评估移植肾功能衰竭患者的结局。
确定移植肾功能衰竭的肾移植受者的肾功能下降速度是否比自身肾脏患有慢性肾脏病的患者更快。
回顾性队列研究。
加拿大艾伯塔省（2002 - 2019年）。
我们确定了移植肾功能衰竭的肾移植受者（2次估算肾小球滤过率[eGFR]测量值为15 - 30 mL/min/1.73 m²，间隔≥90天）。
我们比较了eGFR随时间的变化（eGFR及其95%置信区间）以及肾衰竭和死亡的竞争风险（特定病因风险比[HRs]，HR）。
将受者（n = 575）与倾向评分匹配的、肾功能不全程度相似的非移植对照者（n = 575）进行比较。
中位潜在随访时间为7.8年（四分位间距，3.6 - 12.1年）。受者肾衰竭（HR 1.33）和死亡（HR 1.59）的风险显著更高，而eGFR随时间的下降相似（受者与对照者：每年-2.27 vs -2.21 mL/min/1.73 m²）。eGFR下降速率与肾衰竭相关，但与死亡无关。
这是一项回顾性观察性研究，存在残余混杂导致偏倚的风险。
尽管移植受者中eGFR下降速率与非移植对照者相似，但受者肾衰竭和死亡风险更高。需要开展研究以确定改善移植肾功能衰竭受者结局的预防措施。
