Graft Function Variability and Slope and Kidney Transplantation Outcomes.
Graft Function Variability and Slope and Kidney Transplantation Outcomes.
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移植肾功能变异性和斜率与肾移植结局。
DOI：
10.1016/j.ekir.2021.03.880
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发表时间：
2021-06
影响因子：
6
通讯作者：
Astor BC
中科院分区：
文献类型：
--
作者：
Lyu B;Mandelbrot DA;Djamali A;Astor BC
确定肾移植受者 (KTR) 出现不良结果的风险较高，并重点关注监测和干预措施以改善结果至关重要。我们在一项观察性研究中检查了移植物功能变异性与 KTR 长期结果之间的关联。我们在威斯康星州同种异体移植受者数据库 (WisARD) 中确定了 2919 名 KTR，他们在移植后 2 年具有功能性同种异体移植物，并且在移植后 1 至 2 年内至少进行了 3 次门诊测量估计肾小球滤过率 (eGFR)。移植函数斜率是根据 eGFR 的线性回归计算的，变异性定义为围绕该回归线的变异系数。评估了 eGFR 变异性和斜率与死亡、移植物衰竭、心血管事件和急性排斥反应的关联。与最低四分位数相比，eGFR 变异性的最高四分位数与较高的死亡风险相关（调整后风险比 [HR] = 1.85；95% CI = 1.23−2.76），但与较高的移植失败风险无关（亚风险比 = 1.16；95% CI = 0.85−1.58），与 eGFR 和 eGFR 斜率无关。 eGFR 变异性越大，与心血管和感染相关的死亡和心血管事件的风险越高，但与恶性肿瘤相关的死亡或同种异体移植排斥无关。包括 eGFR 的变异性可显着改善死亡率的预测，但不能改善移植失败的预测。 eGFR 的变异性与死亡风险独立相关，尤其是心血管疾病相关的死亡和心血管事件，但与移植失败无关。 eGFR 的变异性可能有助于识别死亡和心血管事件风险较高的 KTR。
It is critical to identify kidney transplant recipients (KTRs) at higher risk for adverse outcomes, to focus on monitoring and interventions to improve outcomes. We examined the associations between graft function variability and long-term outcomes in KTRs in an observational study. We identified 2919 KTRs in the Wisconsin Allograft Recipient Database (WisARD) who had a functioning allograft 2 years posttransplantation and at least 3 outpatient measurements of estimated glomerular filtration rate (eGFR) from 1 to 2 years posttransplantation. Graft function slope was calculated from a linear regression of eGFR, and variability was defined as the coefficient of variation around this regression line. Associations of eGFR variability and slope with death, graft failure, cardiovascular events, and acute rejection were estimated. Compared to the lowest quartile, the highest quartile of eGFR variability was associated with a higher risk of death (adjusted hazard ratio [HR] = 1.85; 95% CI = 1.23−2.76), but not with a higher risk of graft failure (subhazard ratio = 1.16; 95% CI = 0.85−1.58), independent of eGFR and slope of eGFR. Greater eGFR variability was associated with higher risk of cardiovascular- and infection-related death and cardiovascular events but not malignancy-related death or allograft rejection. Including variability of eGFR significantly improved prediction of mortality but not prediction of graft failure. Variability of eGFR is independently associated with risk of death, especially cardiovascular disease−related death and cardiovascular events, but not graft failure. Variability of eGFR may help identify KTRs at higher risk for death and cardiovascular events.
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影响因子：
2
作者：
Pencina, Michael J.;D'Agostino, Ralph B., Sr.;Steyerberg, Ewout W.
通讯作者：
Steyerberg, Ewout W.
影响因子：
19.6
作者：
Coemans, Maarten;Suesal, Caner;Naesens, Maarten
通讯作者：
Naesens, Maarten
影响因子：
2
作者：
Uno, Hajime;Tian, Lu;Cai, Tianxi;Kohane, Isaac S.;Wei, L. J.
通讯作者：
Wei, L. J.
DOI：
10.1053/j.ajkd.2012.11.048
发表时间：
2013-05
期刊：
American journal of kidney diseases : the official journal of the National Kidney Foundation
影响因子：
--
作者：
Selvin E;Juraschek SP;Eckfeldt J;Levey AS;Inker LA;Coresh J
通讯作者：
Coresh J
影响因子：
4.2
作者：
Pilch, Nicole A.;Rohan, Vinayak;Taber, David J.
通讯作者：
Taber, David J.