中介分析确定了导致外周血管疾病患者肾移植失败率增加的因果因素。
Mediation analysis identifies causal factors that lead to increased rates of kidney transplant failure in patients with peripheral vascular disease.
作者信息
Torikashvili Johnathan, Kendall Melissa A, Zander Tyler, Parikh Rajavi, Kuo Paul C, Grimsley Emily A
机构信息
Department of Surgery, University of South Florida Morsani College of Medicine, Tampa, FL, USA.
Department of Surgery, University of South Florida Morsani College of Medicine, Tampa, FL, USA; Bay Pines Veterans Affairs Health Care System, Bay Pines, FL, USA.
出版信息
Am J Surg. 2025 Mar;241:116190. doi: 10.1016/j.amjsurg.2025.116190. Epub 2025 Jan 7.
BACKGROUND
This study aims to identify causal mediators of one-year kidney transplant failure in patients with peripheral vascular disease.
METHODS
Standard Transplant Analysis and Research database was queried for adults who underwent kidney transplantation from 1987 to 2021. Multi-organ transplant, prior transplant, and living donor kidneys were excluded. Causal mediation analysis with 2000 percentile bootstrapping interactions identified mediators of one-year kidney transplant failure.
RESULTS
212,259 patients were included: 16,215 with and 196,044 without peripheral vascular disease. Causal mediators of one-year kidney transplant failure are Kidney Donor Profile Index (proportionate mediation [PM] 17 %, p < 0.01, E-value = 1.20), pre-transplant dialysis (PM 19 %, p < 0.001, E-value = 1.17), recipient total serum albumin (PM 2 %, p = 0.003, E-value = 1.05), and donor hypertension (PM 1 %, p = 0.017, E-value = 1.04).
CONCLUSIONS
Several causal mediators increase rates of one-year kidney transplant failure in patients with peripheral vascular disease. Understanding these mediators can improve pre-transplant assessments and post-transplant outcomes.
背景
本研究旨在确定外周血管疾病患者肾移植一年失败的因果中介因素。
方法
查询标准移植分析与研究数据库，纳入1987年至2021年接受肾移植的成年人。排除多器官移植、既往移植和活体供肾。采用2000百分位数自抽样交互作用的因果中介分析确定肾移植一年失败的中介因素。
结果
共纳入212,259例患者：16,215例患有外周血管疾病，196,044例未患外周血管疾病。肾移植一年失败的因果中介因素包括肾脏供体特征指数（比例中介[PM]17%，p<0.01，E值=1.20）、移植前透析（PM 19%，p<0.001，E值=1.17）、受者总血清白蛋白（PM 2%，p=0.003，E值=1.05）和供体高血压（PM 1%，p=0.017，E值=1.04）。
结论
多种因果中介因素会增加外周血管疾病患者肾移植一年失败的发生率。了解这些中介因素有助于改善移植前评估和移植后结局。
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