Impact of metabolic syndrome on graft function and survival after cadaveric renal transplantation
Impact of metabolic syndrome on graft function and survival after cadaveric renal transplantation
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DOI：
10.1053/j.ajkd.2006.04.078
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发表时间：
2006-07-01
影响因子：
13.2
通讯作者：
Torres, Armando
中科院分区：
文献类型：
--
作者：
Porrini, Esteban;Delgado, Patricia;Torres, Armando
背景：肾移植后代谢综合征的患病率和后果尚不清楚。我们的目的是分析无糖尿病的连续肾移植受者的历史队列：(1)代谢综合征的患病率及其向移植后新发糖尿病（PTDM）的演变；(2)其对移植物功能和移植物及患者生存的影响。方法：我们研究了230例在1年（基线）和至少18个月的随访（评估日期）后移植物功能稳定的移植受者。代谢综合征的定义采用成人治疗组III标准，稍作修改。结果：22.6%的移植受者在基线时存在代谢综合征，在评估日增加到37.7%。在随访期间，基线时有代谢综合征的移植受者比无代谢综合征的移植受者更容易发生PTDM （P < 0.001）。多元线性回归分析显示，代谢综合征是降低随访期间血清肌酐逆值（1/Cr）的独立危险因素（P = 0.038）。在Cox比例分析中，1/Cr随时间降低30%的风险比为2.6（95%可信区间，1.3 ~ 5.1;P = 0.005）。代谢综合征组的移植物存活率显著降低（P = 0.008），多因素Cox分析结果显示这一差异仍显著（不同模型的风险比为3 ~ 4.5）。代谢综合征组患者生存率也显著降低（P = 0.02）。结论：代谢综合征是肾移植术后PTDM、慢性移植物功能障碍、移植物丢失和患者死亡的重要危险因素。由于代谢综合征是一组可改变的因素，及时干预可以预防其后果。
Background: The prevalence and consequences of metabolic syndrome after renal transplantation are not well established. Our aims are to analyze in a historic cohort of consecutive renal transplant recipients without diabetes: (1) the prevalence of metabolic syndrome and its evolution to de novo posttransplantation diabetes mellitus (PTDM), and (2) its impact on graft function and graft and patient survival. Methods: We studied 230 transplant recipients with stable graft function at 1 year (baseline) and at least 18 months of follow-up (assessment date). Metabolic syndrome is defined using the Adult Treatment Panel III criteria with a slight modification. Results: Metabolic syndrome was present in 22.6% of transplant recipients at baseline, increasing to 37.7% at assessment date. Transplant recipients with metabolic syndrome at baseline more frequently developed PTDM during follow-up than those without metabolic syndrome (P < 0.001). In multiple linear regression analysis, metabolic syndrome was an independent risk factor for decreasing inverse serum creatinine (1/Cr) during follow-up (P = 0.038). In Cox proportional analysis, the hazard ratio for a 30% decrease in 1/Cr over time was 2.6 (95% confidence interval, 1.3 to 5.1; P = 0.005). Graft survival was significantly lower in the metabolic-syndrome group (P = 0.008) and remained significant in multivariate Cox analysis (hazard ratios, 3 to 4.5 in different models). Patient survival also was significantly lower in the metabolic-syndrome group (P = 0.02). Conclusion: Metabolic syndrome is a prominent risk factor for PTDM, chronic graft dysfunction, graft loss, and patient death in renal transplant recipients. Because metabolic syndrome is a cluster of modifiable factors, prompt intervention may prevent its consequences.