Outcomes after kidney transplantation of patients previously diagnosed with atrial fibrillation.
Outcomes after kidney transplantation of patients previously diagnosed with atrial fibrillation.
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DOI：
10.1111/ajt.12197
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发表时间：
2013-06
期刊：
影响因子：
--
通讯作者：
Winkelmayer WC
中科院分区：
文献类型：
--
作者：
Lenihan CR;Montez-Rath ME;Scandling JD;Turakhia MP;Winkelmayer WC
对于接受肾移植的房颤/房扑（AF）患者的患病率和结局知之甚少。我们确定了所有在接受首次肾移植前（1996-2009年）有>1年不间断Medicare A+B覆盖的患者。移植前房颤的存在是根据医疗保险医生索赔中的诊断代码确定的。我们使用多变量考克斯回归研究了移植后死亡、全因移植失败、死亡删失移植失败和卒中的结局。在研究的62，706例符合条件的首次肾移植受者中，3794例（6.4%）在肾移植前被诊断为AF。在平均4.9年的随访中，40.6%的AF患者和24.9%的非AF患者死亡。AF组的全因和死亡删失移植物衰竭分别为46.8%和16.5%，无AF组分别为36.4%和19.5%。缺血性卒中发生在2.8%的AF患者和1.6%的无AF患者中。死亡、移植失败、死亡删失的移植失败和缺血性卒中的95%置信区间为1.46（1.38-1.54）、1.41（1.34-1.48）、1.26（1.15-1.37）和1.36（1.10-1.68）。既存AF与移植后不良结局相关。在肾移植候选人的移植前评估、咨询和风险分层中应特别注意AF。
Little is known about the prevalence and outcomes of patients with atrial fibrillation/flutter (AF) who receive a kidney transplant. We identified all patients who had >1 year of uninterrupted Medicare A+B coverage before receiving their first kidney transplant (1996–2009). The presence of pre-transplant AF was ascertained from diagnosis codes in Medicare physician claims. We studied the post-transplant outcomes of death, all-cause graft failure, death-censored graft failure, and stroke using multivariable Cox regression. Of 62,706 eligible first kidney transplant recipients studied, 3794 (6.4%) were diagnosed with AF prior to kidney transplant. Over a mean follow-up of 4.9 years, 40.6% of AF patients and 24.9% without AF died. All-cause and death-censored graft failure were 46.8% and 16.5%, respectively, in the AF group and 36.4% and 19.5%, respectively, in those without AF. Ischemic stroke occurred in 2.8% of patients with and 1.6% of patients without AF. In patients with AF, multivariable-adjusted hazard ratios (95% confidence intervals) for death, graft failure, death-censored graft failure, and ischemic stroke were 1.46 (1.38–1.54), 1.41 (1.34–1.48), 1.26 (1.15–1.37) and 1.36 (1.10–1.68), respectively. Pre-existing AF is associated with poor post-transplant outcomes. Special attention should be paid to AF in pre-transplant evaluation, counseling, and risk stratification of kidney transplant candidates.
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