Division of Nephrology, University of Arizona, Tucson, AZ, United States.
Department of Surgery, New York University Langone Health, New York City, NY, United States.
Transpl Int. 2023 Jul 14;36:11373. doi: 10.3389/ti.2023.11373. eCollection 2023.
The independent effects of deceased donor kidney length and vascular plaque on long-term graft survival are not established. Utilizing DonorNet attachments from 4,480 expanded criteria donors (ECD) recovered between 2008 and 2012 in the United States with at least one kidney biopsied and transplanted, we analyzed the relationship between kidney length and vascular plaques and 10-year hazard of all-cause graft failure (ACGF) using causal inference methods in a Cox regression framework. The composite plaque score (range 0-4) and the presence of any plaque (yes, no) was also analyzed. Kidney length was modeled both categorically (<10, 10-12, >12 cm) as well as numerically, using a restricted cubic spline to capture nonlinearity. Effects of a novel composite plaque score 4 vs. 0 (HR 1.08; 95% CI: 0.96, 1.23) and the presence of any vascular plaque (HR 1.08; 95% CI: 0.98, 1.20) were attenuated after adjustment. Likewise, we identified a potential nonlinear relationship between kidney length and the 10-year hazard of ACGF, however the strength of the relationship was attenuated after adjusting for other donor factors. The independent effects of vascular plaque and kidney length on long-term ECD graft survival were found to be minimal and should not play a significant role in utilization.
死者供体肾脏长度和血管斑块对长期移植物存活的独立影响尚未确定。本研究利用美国 2008 年至 2012 年间从 4480 名扩展标准供体（ECD）中获取的 DonorNet 附件，这些供体至少有一个肾脏进行了活检和移植。我们分析了肾脏长度与血管斑块之间的关系，以及在 Cox 回归框架中的因果推理方法分析了斑块复合评分（范围 0-4）和任何斑块的存在（是/否）与 10 年全因移植物失败（ACGF）风险之间的关系。肾脏长度采用分类（<10、10-12、>12cm）和数值模型，使用限制立方样条捕捉非线性。新型斑块复合评分 4 与 0 （HR 1.08；95%CI：0.96，1.23）和任何血管斑块的存在（HR 1.08；95%CI：0.98，1.20）之间的关系在调整后减弱。同样，我们发现肾脏长度与 ECD 移植物 10 年 ACGF 风险之间存在潜在的非线性关系，但在调整其他供体因素后，这种关系的强度减弱。血管斑块和肾脏长度对 ECD 移植物长期存活的独立影响被认为很小，不应在使用中发挥重要作用。
