Timing of Pregnancy After Kidney Transplantation and Risk of Allograft Failure
Timing of Pregnancy After Kidney Transplantation and Risk of Allograft Failure
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DOI：
10.1111/ajt.13773
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发表时间：
2016-08-01
影响因子：
8.8
通讯作者：
Gill, J. S.
中科院分区：
文献类型：
--
作者：
Rose, C.;Gill, J.;Gill, J. S.
肾移植后妊娠的最佳时机仍然不确定。我们确定了在移植后3年内怀孕的妇女中同种异体移植失败的风险。在1990年至2010年期间在美国肾脏数据系统中捕获的21814名年龄在15-45岁之间接受首次仅肾脏移植的女性中，使用医疗保险索赔确定了n = 729例妊娠。在妊娠后1、3和5年，任何原因导致的移植物失败（包括死亡）的概率（ACGL）分别为9.6%、25.9%和36.6%。在多变量分析中，移植后第一年妊娠与ACGL风险增加相关（风险比[HR]：1.18; 95%置信区间[CI] 1.00，1.40）和死亡删失移植物丢失（DCGL）（HR：1.25; 95% CI 1.04，1.50），而移植后第二年妊娠与DCGL风险增加相关。（HR：1.26; 95% CI 1.06，1.50）。移植后第三年妊娠与ACGL或DCGL风险增加无关。这些研究结果表明，妊娠后移植肾衰竭的发生率高于以前的报道，移植肾衰竭的风险增加延伸到妊娠后的第二个posttransplantyear.This研究表明，妊娠后移植肾衰竭的发生率高于以前的报道，移植肾衰竭的风险增加延伸到妊娠后的第二年移植。
The optimal timing of pregnancy after kidney transplantation remains uncertain. We determined the risk of allograft failure among women who became pregnant within the first 3 posttransplant years. Among 21 814 women aged 15-45 years who received a first kidney-only transplant between 1990 and 2010 captured in the United States Renal Data System, n = 729 pregnancies were identified using Medicare claims. The probability of allograft failure from any cause including death (ACGL) at 1, 3, and 5 years after pregnancy was 9.6%, 25.9%, and 36.6%. In multivariate analyses, pregnancy in the first posttransplant year was associated with an increased risk of ACGL (hazard ratio [HR]: 1.18; 95% confidence interval [CI] 1.00, 1.40) and death censored graft loss (DCGL) (HR:1.25; 95% CI 1.04, 1.50), while pregnancy in the second posttransplant year was associated with an increased risk of DCGL (HR: 1.26; 95% CI 1.06, 1.50). Pregnancy in the third posttransplant year was not associated with an increased risk of ACGL or DCGL. These findings demonstrate a higher incidence of allograft failure after pregnancy than previously reported and that the increased risk of allograft failure extends to pregnancies in the second posttransplant year.This study demonstrates a higher incidence of kidney allograft failure after pregnancy than previously reported, and the increased risk of allograft failure extends to pregnancies in the second year posttransplant.