Kidney Transplantation Outcomes across GN Subtypes in the United States
Kidney Transplantation Outcomes across GN Subtypes in the United States
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DOI：
10.1681/asn.2016020126
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发表时间：
2017-02-01
影响因子：
13.6
通讯作者：
Winkelmayer, Wolfgang C.
中科院分区：
文献类型：
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作者：
O'Shaughnessy, Michelle M.;Liu, Sai;Winkelmayer, Wolfgang C.
GN亚型之间肾移植结果的差异很少被研究。从美国肾脏数据系统中，我们确定了所有成人（>= 18岁）首次肾移植受者（1996-2011年）的ESRD归因于六种GN亚型之一或两种对照肾脏疾病。我们使用考克斯比例风险回归计算了死亡、全因同种异体移植失败和排除死亡原因的同种异体移植失败（竞争风险框架）的风险比（HR）。在研究的32，131名GN患者中，伊加肾病（IgAN）患者的死亡率最低，IgAN或血管炎患者的同种异体移植失败率最低。在调整患者和移植相关因素后，与IgAN相比，（参考）、FSGS、膜性肾病、膜性增生性GN、狼疮性肾炎和与HR相关的血管炎（95%置信区间）为1.57（1.43至1.72）、1.52（1.34至1.72），1.76（1.55至2.01）、1.82（1.63至2.02）和1.56（1.34至1.81），不包括死亡原因的同种异体移植失败的HR为1.20（1.12至1.28）、1.27（1.14至1.41）、1.50（1.36至1.66）、1.11（1.02至1.20）和0.94（0.81至1.09）。考虑外部对照组，并与IgAN、常染色体显性遗传性多囊肾病（ADPKD）和糖尿病肾病进行比较，其死亡率的HR较高[1.22（1.12至1.34）和2.57（分别为2.35至2.82）]，但ADPKD与排除死亡原因的同种异体移植物失败的HR较低相关[0.85（0.79至0.91）]。GN亚型和终末期肾病的病因导致不同结局的原因应在未来的研究中进行检查。
Differences in kidney transplantation outcomes across GN subtypes have rarely been studied. From the US Renal Data System, we identified all adult (>= 18 years) first kidney transplant recipients (1996-2011) with ESRD attributed to one of six GN subtypes or two comparator kidney diseases. We computed hazard ratios (HRs) for death, all-cause allograft failure, and allograft failure excluding death as a cause (competing risks framework) using Cox proportional hazards regression. Among the 32,131 patients with GN studied, patients with IgA nephropathy (IgAN) had the lowest mortality rates and patients with IgAN or vasculitis had the lowest allograft failure rates. After adjusting for patient- and transplant-related factors, compared with IgAN (referent), FSGS, membranous nephropathy, membranoproliferative GN, lupus nephritis, and vasculitis associated with HRs (95% confidence intervals) for death of 1.57 (1.43 to 1.72), 1.52 (1.34 to 1.72), 1.76 (1.55 to 2.01), 1.82 (1.63 to 2.02), and 1.56 (1.34 to 1.81), respectively, and with HRs for allograft failure excluding death as a cause of 1.20 (1.12 to 1.28), 1.27 (1.14 to 1.41), 1.50 (1.36 to 1.66), 1.11 (1.02 to 1.20), and 0.94 (0.81 to 1.09), respectively. Considering external comparator groups, and comparing with IgAN, autosomal dominant polycystic kidney disease (ADPKD) and diabetic nephropathy associated with higher HRs for mortality [1.22 (1.12 to 1.34) and 2.57 (2.35 to 2.82), respectively], but ADPKD associated with a lower HR for allograft failure excluding death as a cause [0.85 (0.79 to 0.91)]. Reasons for differential outcomes by GN subtype and cause of ESRD should be examined in future research.