Burden of early hospitalization after simultaneous liver-kidney transplantation: Results from the US Multicenter SLKT Consortium.
Burden of early hospitalization after simultaneous liver-kidney transplantation: Results from the US Multicenter SLKT Consortium.
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同时肝肾移植后早期住院的负担：来自美国多中心 SLKT 联盟的结果。
DOI：
10.1002/lt.26523
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发表时间：
2022
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作者：
Sharma,Pratima;Xie,Jiaheng;Wang,Leyi;Zhang,Min;Magee,John;Answine,Adeline;Barman,Pranab;Jo,Jennifer;Sinha,Jasmine;Schluger,Aaron;Perreault,GabrielJ;Walters,KaraE;Cullaro,Giuseppe;Wong,Randi;Filipek,Natalia;Biggins,ScottW;
同时进行肝肾移植（SLKT）后早期住院（6个月内）的负担尚不清楚。我们研究了SLKT术后早期住院相关的危险因素及其对患者6个月生存率的影响。我们使用了来自美国多中心SLKT联盟队列研究的数据，该研究纳入了2002年至2017年间SLKT术后存活出院的所有成人SLKT受者。我们使用泊松回归对SLKT后早期住院率进行建模。Cox回归用于确定SLKT后6个月生存率与死亡率相关的危险因素。中位年龄（N= 549）为57.7岁（四分位数间距[IQR]， 50.6-63.9），男性63%，白人76%；33%患有丙型肝炎病毒，20%患有非酒精相关性脂肪肝，23%患有酒精相关性肝病，24%患有其他病因。中位体重指数（BMI）和终末期肝病模型-钠评分分别为27.2 kg/m2（IQR, 23.6-32.2 kg/m2）和28 （IQR, 23-34）。三分之二的队列患者在SLKT的前6个月内至少住院一次。年龄、种族、SLKT住院、糖尿病、BMI和SLKT术后亚急性康复（SAR）出院与早期住院的高发生率独立相关。前6个月内的住院次数不影响有条件生存。SLKT后早期住院治疗很常见，但不影响有条件生存。虽然早期住院的大多数危险因素是不可改变的，但初始SLKT后出院到SAR与早期住院的发生率显著升高相关。努力和资源应集中在识别早期住院高风险的SLKT受者，以优化其出院前护理、出院计划和长期随访。
The burden of early hospitalization (within 6 months) following simultaneous liver–kidney transplant (SLKT) is not known. We examined risk factors associated with early hospitalization after SLKT and their impact on patient mortality conditional on 6‐month survival. We used data from the US Multicenter SLKT Consortium cohort study of all adult SLKT recipients between 2002 and 2017 who were discharged alive following SLKT. We used Poisson regression to model rates of early hospitalizations after SLKT. Cox regression was used to identify risk factors associated with mortality conditional on survival at 6 months after SLKT. Median age (N= 549) was 57.7 years (interquartile range [IQR], 50.6–63.9) with 63% males and 76% Whites; 33% had hepatitis C virus, 20% had non–alcohol‐associated fatty liver disease, 23% alcohol‐associated liver disease, and 24% other etiologies. Median body mass index (BMI) and Model for End‐Stage Liver Disease–sodium scores were 27.2 kg/m2(IQR, 23.6–32.2 kg/m2) and 28 (IQR, 23–34), respectively. Two‐thirds of the cohort had at least one hospitalization within the first 6 months of SLKT. Age, race, hospitalization at SLKT, diabetes mellitus, BMI, and discharge to subacute rehabilitation (SAR) facility after SLKT were independently associated with a high incidence rate ratio of early hospitalization. Number of hospitalizations within the first 6 months did not affect conditional survival. Early hospitalizations after SLKT were very common but did not affect conditional survival. Although most of the risk factors for early hospitalization were nonmodifiable, discharge to SAR after initial SLKT was associated with a significantly higher incidence rate of early hospitalization. Efforts and resources should be focused on identifying SLKT recipients at high risk for early hospitalization to optimize their predischarge care, discharge planning, and long‐term follow‐up.