Department of Cardiovascular Medicine, Yingtan People's Hospital, Jiangxi, P.R. China.
Department of Cardiovascular Medicine, The Third Hospital of Nanchang, Jiangxi, P.R. China.
Medicine (Baltimore). 2024 Sep 13;103(37):e39568. doi: 10.1097/MD.0000000000039568.
The purpose of this study was to investigate gender differences in cardiovascular outcomes of kidney transplant recipients (KTRs). Here, a retrospective cohort study was conducted, and data from the National Health Insurance Research Database in Taiwan were used. In total, 2904 patients who had end-stage renal disease (ERSD) and received kidney transplantation (KT) were identified by propensity score matching (PSM) and were enrolled from 1997 to 2012, with follow-up ending in 2013. Besides, major adverse cardiovascular events (MACEs) were defined as a composite of all-cause mortality, nonfatal myocardial infarction, and nonfatal strokes. Apart from that, hazard ratios (HRs) and 95% confidence intervals (CIs) were calculated by Cox regression, while the Bayesian network model was constructed to assess the importance of risk factors for MACEs. Furthermore, the original cohort was a sensitivity analysis. Women had a lower risk of MACEs compared with men (hazard ratio [HR]: 0.84; 95% CI: 0.72-0.98; P = .024). Beyond that, stratified analysis of age and waiting time for KT showed that the risk of MACEs was significantly lower in women than in men among KTRs aged > 50 years (HR: 0.79; 95% CI: 0.62-1.0; P = .05) or waiting time for KT ≤ 6 years (HR: 0.85; 95% CI: 0.72-0.99; P = .04). Bayesian network indicated that age is an important determinant of cardiovascular outcomes in KTRs, regardless of gender. In Taiwan, women had a lower risk of adverse cardiovascular outcomes than men in KTRs aged > 50 years or with a waiting time for KT ≤ 6 years. Furthermore, age is an important independent determinant for the prognosis of KTRs.
本研究旨在探讨肾移植受者（KTR）心血管结局的性别差异。采用回顾性队列研究，使用台湾全民健康保险研究数据库的数据。通过倾向评分匹配（PSM）共确定了 2904 名患有终末期肾病（ESRD）并接受肾移植（KT）的患者，这些患者来自 1997 年至 2012 年，随访至 2013 年结束。此外，主要不良心血管事件（MACEs）定义为全因死亡率、非致死性心肌梗死和非致死性卒中的综合指标。除此之外，通过 Cox 回归计算风险比（HR）和 95%置信区间（CI），并构建贝叶斯网络模型来评估 MACEs 危险因素的重要性。此外，原始队列进行了敏感性分析。与男性相比，女性发生 MACEs 的风险较低（风险比[HR]：0.84；95%CI：0.72-0.98；P=0.024）。此外，分层分析年龄和 KT 等待时间表明，在年龄>50 岁的 KTR 中（HR：0.79；95%CI：0.62-1.0；P=0.05）或 KT 等待时间≤6 年的 KTR 中（HR：0.85；95%CI：0.72-0.99；P=0.04），女性发生 MACEs 的风险明显低于男性。贝叶斯网络表明，年龄是 KTR 心血管结局的重要决定因素，与性别无关。在台湾，年龄>50 岁或 KT 等待时间≤6 年的 KTR 中，女性发生不良心血管结局的风险低于男性。此外，年龄是 KTR 预后的重要独立决定因素。
