Exponentially increased risk of infectious death in older renal transplant recipients
Exponentially increased risk of infectious death in older renal transplant recipients
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DOI：
10.1046/j.1523-1755.2001.0590041539.x
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发表时间：
2001-04-01
影响因子：
19.6
通讯作者：
Kaplan, B
中科院分区：
文献类型：
--
作者：
Meier-Kriesche, HU;Ojo, AO;Kaplan, B
背景。肾移植对终末期肾病（ESRD）患者的益处已得到充分证明。所有年龄段的患者都可以看到这种益处。然而，有记录表明，与年轻的接受者相比，老年肾移植接受者因感染原因死亡的风险更高。本研究探讨了这种风险的增加是否仅仅与年龄相关的感染死亡率的增加相一致，还是反映了老年肾移植受者的特殊脆弱性。方法。利用美国肾脏数据系统 (USRDS) 数据库对 1988 年至 1997 年间排队和移植的患者进行了分析。主要研究终点是患者继发感染死亡。次要终点包括心血管原因和恶性肿瘤继发的死亡。 Cox 比例风险模型与所有相关变量一起使用。结果。随着年龄的增加，移植患者中与感染相关的死亡呈指数增加（斜率 = 2.9（0.34x）），而对于等待名单上的患者，则随着年龄的增加呈线性增加（斜率 = 1.9x + 8.6）。等待名单组和移植组之间随年龄增长的总体死亡率增加是相等的。结论。在老年组中，移植的总体生存获益得以维持。然而，肾移植与感染性死亡风险增加相关，超出了肾移植等待名单上患者与年龄相关的预期风险增加。这可能会影响该人群未来的免疫抑制治疗方案。
Background. The benefit of renal transplantation for patients with end-stage renal disease (ESRD) has been well documented. This benefit is seen throughout all age ranges of patients. However, it has been documented that older renal transplant recipients are at increased risk for death because of infectious causes when compared with younger recipients. The present study addresses whether this increased risk merely parallels an age-related increase in infectious mortality or is reflective of a particular vulnerability in older renal transplant recipients.Methods. Patients wait-listed and transplanted between 1988 and 1997 were analyzed utilizing the United States Renal Data System (USRDS) database. The primary study end point was patient death secondary to infection. Secondary end points included death secondary to cardiovascular cause and malignancy. Cox-proportional hazard models were utilized with all pertinent variables.Results. Death related to infectious cause increased exponentially in transplanted patients with increasing age (slope = 2.9(0.34x)), while it increased linearly (slope = 1.9x + 8.6) with increasing age for those patients on the waiting list. Overall mortality increases with age were equal between the wait-listed and transplanted groups.Conclusions. The overall survival benefit of transplantation is maintained in the older age groups. However, renal transplantation is associated with an increased risk for infectious death beyond the expected age-related increased risk in patients on the renal transplant waiting list. This may have an impact on future immunosuppressive regimens in this population.