Thorsen Inga Strand, Bleskestad Inger Hjørdis, Åsberg Anders, Jonsson Grete, Skadberg Øyvind, Heldal Kristian, Gøransson Lasse Gunnar
Department of Internal Medicine, Stavanger University Hospital, Stavanger, Norway.
Department of Clinical Medicine, University of Bergen, Bergen, Norway.
Transplant Direct. 2023 Aug 9;9(9):e1522. doi: 10.1097/TXD.0000000000001522. eCollection 2023 Sep.
Short-term survival after kidney transplantation is excellent but long-term survival remains suboptimal. The aim of the study was to explore the relationship between soluble α-Klotho (sKlotho) and intact fibroblast growth factor 23 (iFGF23) measured 8 wk and 1 y posttransplant with long-term graft- and patient survival in a cohort of kidney transplant recipients with deficient and nondeficient vitamin D (25[OH]D) levels.
Vitamin D, sKlotho, and iFGF23 were measured 8 wk and 1 y posttransplant in 132 recipients transplanted between November 2012 and October 2013.
Of the 132 kidney transplant recipients, 49 had deficient vitamin D levels (<30 nmol/L) and 83 had nondeficient vitamin D levels (≥30 nmol/L) at 8 wk posttransplant. The mean age was 51 y and the median follow-up was 7.4 y. At 1 y posttransplant, vitamin D increased significantly. There were no significant differences in sKlotho or iFGF23 levels between the 2 vitamin D groups neither at 8 wk nor 1 y. sKlotho increased significantly and iFGF23 decreased significantly in the whole cohort. During the follow-up, there were 36 graft losses (27%) and 27 deaths (20%). Ninety-four percent of the transplant recipients with nondeficient vitamin D levels were alive with a well-functioning graft after 5 y using Kaplan-Meier survival estimates, compared with 84% of the patients with deficient vitamin D levels ( = 0.014). Klotho and FGF23 levels did not influence graft- and patient survival.
In this nationwide cohort of kidney transplant recipients, long-term graft- and patient survival were significantly better in patients with vitamin D ≥30 nmol/L 8 wk posttransplant compared with those with vitamin D <30 nmol/L. sKlotho levels increased and iFGF23 levels decreased from 8 wk to 1 y posttransplant. Klotho and FGF23 levels were not associated with graft- and patient survival.
肾移植后的短期生存率很高，但长期生存率仍不理想。本研究的目的是在一组维生素D（25[OH]D）水平缺乏和不缺乏的肾移植受者中，探讨移植后8周和1年时测量的可溶性α-klotho（sKlotho）和完整成纤维细胞生长因子23（iFGF23）与长期移植物和患者生存率之间的关系。
对2012年11月至2013年10月间移植的132名受者在移植后8周和1年时测量维生素D、sKlotho和iFGF23。
132名肾移植受者中，49名在移植后8周时维生素D水平缺乏（<30 nmol/L），83名维生素D水平不缺乏（≥30 nmol/L）。平均年龄为51岁，中位随访时间为7.4年。移植后1年时，维生素D显著升高。两个维生素D组在8周和1年时sKlotho或iFGF23水平均无显著差异。整个队列中sKlotho显著升高，iFGF23显著降低。随访期间，有36例移植物丢失（27%）和27例死亡（20%）。使用Kaplan-Meier生存估计，5年后维生素D水平不缺乏的移植受者中有94%存活且移植物功能良好，而维生素D水平缺乏的患者为84%（P=0.014）。Klotho和FGF23水平不影响移植物和患者生存率。
在这个全国性的肾移植受者队列中，移植后8周维生素D≥30 nmol/L的患者长期移植物和患者生存率显著高于维生素D<30 nmol/L的患者。移植后8周到1年，sKlotho水平升高，iFGF23水平降低。Klotho和FGF23水平与移植物和患者生存率无关。
