Department of Nephrology and Transplantation, University Hospitals Birmingham, Birmingham, UK.
University Hospital of North Midlands, Stoke on Trent, UK.
Diabetologia. 2024 Nov;67(11):2530-2538. doi: 10.1007/s00125-024-06245-x. Epub 2024 Aug 6.
AIMS/HYPOTHESIS: It is unclear whether kidney transplant candidates with diabetes have equitable transplantation opportunities or have divergent survival probabilities stratified by kidney replacement therapy. The aim of this study was to investigate these two issues using national transplant registry data in the UK.
A cohort study was undertaken of prospectively collected registry data of all wait-listed people with kidney failure receiving dialysis in the UK. All people listed for their first kidney-alone transplant between 2000 and 2019 were included. Stratification was done for cause of kidney failure. Primary outcome was all-cause mortality. Time-to-death from listing was analysed using adjusted non-proportional hazard Cox regression models, with transplantation handled as a time-dependent covariate.
A total of 47,917 wait-listed people with kidney failure formed the total study cohort, of whom 6594 (13.8%) had diabetes classified as cause of kidney failure. People with kidney failure with diabetes comprised 27.6% of the cohort (n=3681/13,359) that did not proceed to transplantation vs only 8.4% (n=2913/34,558) of the cohort that received a transplant (p<0.001). Kidney transplant candidates with diabetes were more likely to be older, of male sex and of ethnic minority background compared with those without diabetes. In an adjusted analysis, compared with remaining on dialysis, any kidney transplant provided survival benefit for wait-listed kidney transplant candidates regardless of diabetes as cause of kidney failure (RR 0.26 [95% CI 0.25, 0.27], p<0.001).
CONCLUSIONS/INTERPRETATION: Kidney transplant candidates with diabetes have a lower chance of transplantation despite better survival after kidney transplantation vs remaining on dialysis. The reasons for this require further investigation to ensure equal transplantation opportunities.
目的/假设：目前尚不清楚患有糖尿病的肾移植候选者是否具有平等的移植机会，或者在接受肾脏替代治疗时是否具有不同的生存概率。本研究的目的是使用英国国家移植登记处的数据来调查这两个问题。
对英国所有接受透析的肾衰竭等待名单上的患者前瞻性收集的登记数据进行了队列研究。所有在 2000 年至 2019 年间接受单肾移植的患者均被纳入研究。根据肾衰竭的病因进行分层。主要结局是全因死亡率。使用调整后的非比例风险 Cox 回归模型分析从列入名单到死亡的时间，将移植作为时间依赖性协变量进行处理。
共有 47917 名肾衰竭等待名单上的患者构成了总研究队列，其中 6594 名（13.8%）患有糖尿病，被归类为肾衰竭的病因。患有糖尿病的肾衰竭患者占未进行移植的队列的 27.6%（n=3681/13359），而仅占接受移植的队列的 8.4%（n=2913/34558）（p<0.001）。与没有糖尿病的患者相比，患有糖尿病的肾移植候选者更有可能年龄较大、为男性且为少数民族背景。在调整后的分析中，与继续透析相比，任何类型的肾移植都为等待肾移植的候选者提供了生存获益，无论其糖尿病是否为肾衰竭的病因（RR 0.26 [95%CI 0.25, 0.27]，p<0.001）。
结论/解释：尽管接受肾移植后生存获益更好，但患有糖尿病的肾移植候选者接受移植的机会较低。需要进一步调查其原因，以确保平等的移植机会。
