Is delayed graft function causally associated with long-term outcomes after kidney transplantation? Instrumental variable analysis.
Is delayed graft function causally associated with long-term outcomes after kidney transplantation? Instrumental variable analysis.
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DOI：
10.1097/tp.0b013e3182855544
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发表时间：
2013-04-27
期刊：
影响因子：
6.2
通讯作者：
Parikh CR
中科院分区：
文献类型：
--
作者：
Butala NM;Reese PP;Doshi MD;Parikh CR
虽然一些研究发现肾移植后移植物功能延迟（DGF）与长期预后不良之间存在关联，但因果关系仍存在争议。我们使用工具变量模型（IVM）研究了这种关系，这是一种用于绘制因果推断的准随机化技术。我们从1997年至2010年期间的移植受体科学登记处确定了80，690名成年，死亡供体，仅肾脏移植受体。我们使用冷缺血时间（CIT）作为一种工具来检验DGF导致移植后1年和5年的死亡删失移植物丢失和死亡的假设，控制已知影响患者和移植物存活的一系列特征。我们将IVM结果与多变量线性概率模型（LPM）进行了比较。DGF发生在我们的样本的27%。1年和5年的移植物丢失率分别为6%和22%，1年和5年的死亡率分别为5%和20%。在LPM中，DGF与1年和5年时移植物丢失和死亡的风险增加相关（p<0.001）。在IVM中，我们发现有证据表明DGF与1年（增加13.5%; p<0.001）和5年（增加16.2%; p<0.001）的死亡删失之间存在因果关系，DGF与1年（增加7.1%; p<0.001）和5年（增加11.0%; p<0.01）的死亡率之间存在因果关系。排除低质量以及泵肾和使用基于肌酐的DGF定义的结果是稳健的。工具变量分析支持DGF与移植物丢失和死亡之间的因果关系。
While some studies have found an association between delayed graft function (DGF) after kidney transplantation and worse long-term outcomes, a causal relationship remains controversial. We investigated this relationship using an instrumental variables model (IVM), a quasi-randomization technique for drawing causal inferences. We identified 80,690 adult, deceased-donor, kidney-only transplant recipients from the Scientific Registry of Transplant Recipients between 1997 and 2010. We used cold ischemia time (CIT) as an instrument to test the hypothesis that DGF causes death-censored graft loss and mortality at 1 and 5 years post-transplant, controlling for an array of characteristics known to affect patient and graft survival. We compared our IVM results to a multivariable linear probability model (LPM). DGF occurred in 27% of our sample. Graft loss rates at 1 and 5 years were 6% and 22%, respectively, and 1-year and 5-year mortality rates were 5% and 20%, respectively. In the LPM, DGF was associated with increased risk of both graft loss and mortality at 1 and 5 years (p<0.001). In the IVM, we found evidence suggesting a causal relationship between DGF and death-censored graft loss at both 1 year (13.5% increase; p<0.001) and 5 years (16.2% increase; p<0.001), and between DGF and mortality at both 1 year (7.1% increase; p<0.001) and 5 years (11.0% increase; p<0.01). Results were robust to exclusion of lower-quality as well as pumped kidneys and use of a creatinine-based definition for DGF. Instrumental variables analysis supports a causal relationship between DGF and both graft loss and mortality.