早期手术并发症对肾移植结局的影响。
Impact of early surgical complications on kidney transplant outcomes.
机构信息
Kidney Transplant Program, Toronto General Hospital, University Health Network, 585 University Avenue, 9-MaRS-9050, Toronto, ON, M5G 2N2, Canada.
Division of General Surgery, University Health Network, Toronto, Canada.
出版信息
BMC Surg. 2024 May 27;24(1):165. doi: 10.1186/s12893-024-02463-7.
BACKGROUND
Kidney transplantation (KT) improves clinical outcomes of patients with end stage renal disease. Little has been reported on the impact of early post-operative surgical complications (SC) on long-term clinical outcomes following KT. We sought to determine the impact of vascular complications, urological complications, surgical site complications, and peri-graft collections within 30 days of transplantation on patient survival, graft function, and hospital readmissions.
METHODS
We conducted a single-centre, observational cohort study examining adult patients (≥ 18 years) who received a kidney transplant from living and deceased donors between January 1st, 2005 and December 31st, 2015 with follow-up until December 31, 2016 (n = 1,334). Univariable and multivariable analyses were performed with Cox proportional hazards models to analyze the outcomes of SC in the early post-operative period after KT.
RESULTS
The cumulative probability of SC within 30 days of transplant was 25%, the most common SC being peri-graft collections (66.8%). Multivariable analyses showed significant relationships between Clavien Grade 1 SC and death with graft function (HR 1.78 [95% CI: 1.11, 2.86]), and between Clavien Grades 3 to 4 and hospital readmissions (HR 1.95 [95% CI: 1.37, 2.77]).
CONCLUSIONS
Early SC following KT are common and have a significant influence on long-term patient outcomes.
背景
肾移植（KT）改善了终末期肾病患者的临床结果。术后早期手术并发症（SC）对 KT 后长期临床结果的影响报道甚少。我们旨在确定移植后 30 天内血管并发症、尿路上皮并发症、手术部位并发症和移植周围积液对患者生存、移植物功能和住院再入院的影响。
方法
我们进行了一项单中心观察性队列研究，纳入了 2005 年 1 月 1 日至 2015 年 12 月 31 日期间接受活体和已故供体肾移植的成年患者（≥18 岁），随访至 2016 年 12 月 31 日（n=1334）。采用 Cox 比例风险模型进行单变量和多变量分析，以分析 KT 后早期术后 SC 的结果。
结果
移植后 30 天内 SC 的累积概率为 25%，最常见的 SC 是移植周围积液（66.8%）。多变量分析显示，Clavien 1 级 SC 与移植物功能丧失相关的死亡（HR 1.78[95%CI：1.11，2.86]）和 Clavien 3 至 4 级 SC 与住院再入院（HR 1.95[95%CI：1.37，2.77]）之间存在显著关系。
结论
KT 后早期 SC 很常见，对长期患者结局有重大影响。
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