Effect of Peripheral Vascular Disease on Kidney Allograft Outcomes: A Study of US Renal Data System
Effect of Peripheral Vascular Disease on Kidney Allograft Outcomes: A Study of US Renal Data System
复制标题
DOI：
10.1097/tp.0b013e31827eef36
复制
发表时间：
2013-03-27
期刊：
影响因子：
6.2
通讯作者：
Salifu, Moro O.
中科院分区：
文献类型：
--
作者：
Brar, Amarpali;Jindal, Rahul M.;Salifu, Moro O.
背景美国肾脏数据系统被用来分析在移植列表时周围血管疾病（PVD）患者的肾移植结果。我们使用了2004年6月至2009年9月期间接受肾移植的患者的事件队列。我们将PVD定义为等待列表中的症状性PVD。合并症包括糖尿病、缺血性心脏病、脑血管疾病、高血压和吸烟。采用卡方检验、t检验和考克斯回归分析。PVD患者的平均移植物生存期为55.3 ± 0.40个月，而无PVD患者的平均移植物生存期为60.8 ± 0.06个月。PVD的移植物失效风险增加（风险比，2.01; 95%置信区间，1.83 Y 2.21; P = 0.0001）。在调整其他变量后，PVD仍然是移植失败的独立风险因素。在1年（93.3% vs. 96.6%）、2年（89.7% vs. 95%）和3年（87.2% vs. 93.7%）时，PVD患者的死亡删失移植物存活率低于无PVD患者。PVD组的全因死亡率高于无PVD组（6.2% vs. 3.0%）。在非裔美国人中，PVD组的平均同种异体移植物生存期为54.8 +/-0.98个月，而非PVD组为59.7 +/-0.135个月（P = 0.0001）。在非非洲裔美国人中，PVD组的平均同种异体移植物生存期为55.4 +/-0.44个月，而非PVD组为61.1 +/-0.069个月（P = 0.0001）。非裔美国人PVD和非裔美国人PVD的生存率没有差异。PVD患者的同种异体移植物和患者生存率低于无PVD患者。将有症状的PVD或截肢患者列入等候名单时应谨慎。
Background. The U.S. Renal Data System was used to analyze renal allograft outcomes in patients with peripheral vascular disease (PVD) at the time of transplant listing.Methods. We used an incident cohort of patients who underwent renal transplantation between June 2004 and September 2009. We defined PVD as symptomatic PVD at wait-listing. Comorbid conditions were diabetes mellitus, ischemic heart disease, cerebrovascular disease, hypertension, and smoking. Chi-square test, Student's t test, and Cox regression were used for statistical associations.Results. The mean graft survival was 55.3 +/- 0.40 months in patients with PVD versus 60.8 +/- 0.06 months in patients without PVD. There was an increased risk of graft failure with PVD (hazard ratio, 2.01; 95% confidence interval, 1.83Y2.21; P=0.0001). After adjusting for other variables, PVD remained an independent risk factor for graft failure. Patients with PVD had lower death-censored graft survival versus patients without PVD at 1 year (93.3% vs. 96.6%), 2 years (89.7% vs. 95%), and 3 years (87.2% vs. 93.7%). All-cause mortality was higher in PVD versus without PVD (6.2% vs. 3.0%). In African Americans, the mean allograft survival was 54.8 +/- 0.98, months with PVD versus 59.7 +/- 0.135 months without PVD (P=0.0001). In non-African Americans, the mean allograft survival was 55.4 +/- 0.44 months with PVD versus 61.1 +/- 0.069 months without PVD (P=0.0001). There were no differences in survival between African Americans with PVD and nonYAfrican Americans with PVD.Conclusions. Patients with PVD have inferior allograft and patient survival versus those without PVD. Caution should be exercised when placing patients with symptomatic PVD or amputation on the wait-list.