Tsai Hsin-Lin, Lin Tzu-Ching, Lin Niang-Cheng, Yang Hui-Hsin, Chang Jei-Wen
Division of Pediatric Surgery, Department of Surgery, Taipei Veterans General Hospital, Taipei, Taiwan.
Faculty of Medicine, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan.
Am J Nephrol. 2023;54(11-12):498-507. doi: 10.1159/000533125. Epub 2023 Oct 2.
Kidney transplant recipients are at an increased risk of fractures, and targeted preventive strategies are needed. Therefore, in this retrospective cohort study, we investigated a large population-based cohort to identify the transplant recipient-specific risk factors for fractures in Taiwanese kidney transplant recipients.
We conducted a retrospective cohort study using the National Health Insurance Research Database. Patients who underwent renal transplantation between 2003 and 2015 were identified and followed until December 31, 2015, to observe the development of fractures. Variables associated with the development of post-transplant fractures were identified by calculating hazard ratios in a Cox regression model.
5,309 renal transplant recipients were identified, of whom 553 (10.4%) were diagnosed with post-transplant fractures. Independent predictors of post-transplant fractures included an age at transplant ≥65 years (p < 0.001), female sex (p < 0.001), fractures within 3 years prior to transplantation (p < 0.001), and diabetes mellitus (p < 0.001). In addition, daily prednisolone doses >2.9–5.3 mg/day (p < 0.001), >5.3–8.7 mg/day (p < 0.001), and >8.7 mg/day (p < 0.001) were also independent predictors of post-transplant fractures. Conversely, the use of peritoneal dialysis before renal transplantation (p = 0.021), hypertension (p = 0.005), and the use of tacrolimus (p < 0.001), azathioprine (p = 0.006), mycophenolate mofetil/mycophenolic acid (p = 0.002), mTOR inhibitors (p = 0.004), and calcium supplements (p = 0.009) were inversely correlated with post-transplant fractures.
We recommend minimizing daily glucocorticoids as early and as far as possible in conjunction with immunosuppressive regimens such as tacrolimus, azathioprine, mycophenolate mofetil/mycophenolic acid, mTOR inhibitors, and calcium supplements, especially in older female recipients and in recipients with diabetes and a history of prior fractures.
肾移植受者骨折风险增加，需要针对性的预防策略。因此，在这项回顾性队列研究中，我们调查了一个基于人群的大型队列，以确定台湾肾移植受者骨折的特定风险因素。
我们使用国民健康保险研究数据库进行了一项回顾性队列研究。确定了2003年至2015年间接受肾移植的患者，并随访至2015年12月31日，以观察骨折的发生情况。通过在Cox回归模型中计算风险比，确定与移植后骨折发生相关的变量。
共确定了5309名肾移植受者，其中553名（10.4%）被诊断为移植后骨折。移植后骨折的独立预测因素包括移植时年龄≥65岁（p<0.001）、女性（p<0.001）、移植前3年内骨折（p<0.001）和糖尿病（p<0.001）。此外，每日泼尼松龙剂量>2.9–5.3毫克/天（p<0.001）、>5.3–8.7毫克/天（p<0.001）和>8.7毫克/天（p<0.001）也是移植后骨折的独立预测因素。相反，肾移植前使用腹膜透析（p=0.021）、高血压（p=0.005）以及使用他克莫司（p<0.001）、硫唑嘌呤（p=0.006）、霉酚酸酯/霉酚酸（p=0.002）、mTOR抑制剂（p=0.004）和钙补充剂（p=0.009）与移植后骨折呈负相关。
我们建议尽早并尽可能减少每日糖皮质激素的使用，同时结合他克莫司、硫唑嘌呤、霉酚酸酯/霉酚酸、mTOR抑制剂和钙补充剂等免疫抑制方案，尤其是在老年女性受者以及患有糖尿病和有既往骨折史的受者中。
