Major Role for Arterial Disease in Morbidity and Mortality After Kidney Transplantation in Diabetic Recipients
Major Role for Arterial Disease in Morbidity and Mortality After Kidney Transplantation in Diabetic Recipients
复制标题
动脉疾病在糖尿病患者肾移植后发病率和死亡率中的主要作用
DOI：
10.2337/diacare.14.4.295
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发表时间：
1991
期刊：
影响因子：
16.2
通讯作者：
J. Barry
中科院分区：
文献类型：
--
作者：
Michael J Lemmer;J. Barry
目的明确糖尿病终末期肾病患者的临床特征，这些特征使个体移植候选者在移植后动脉发病率和死亡率高风险。研究设计和方法：我们研究了101例连续肾移植受者的过程中，胰岛素依赖型糖尿病，移植1980年11月10日至1986年4月1日。动脉疾病的列表来自医疗记录和对个别患者、他们的家人和他们的私人医生的采访。离散动脉事件的记录包括记录的体格检查、放射学研究、实验室数据、心电图、外周血管血流研究和手术报告。术前动脉疾病的患病率与肾移植后新发动脉事件的发生率进行比较。结果平均随访47个月，绝对死亡率为30%。在这些死亡中，57%是由动脉疾病引起的。41%的受者在移植前有动脉疾病的临床表现，78%的受者在移植后发生了新的血管事件。在整个样本中，57%的患者在移植后至少发生了一种新的动脉疾病并发症，而只有34%的患者在移植前后没有血管诊断。脑，冠状动脉和外周动脉并发症分别发生在14%，28%和36%的患者移植后。相应的卒中、心肌梗死和截肢发生率分别为12%、14%和25%。移植前冠状动脉疾病易导致移植后新冠状动脉事件，但与术前相比，移植后仅外周动脉并发症更常见。动脉并发症或死亡的概率与首次移植时患者的年龄和糖尿病持续时间相关，但与性别或吸烟史无关。结论糖尿病肾移植受者的动脉病变是移植术后远期并发症和死亡的重要原因，是影响移植受者生存的主要因素。年龄>35岁或有动脉疾病临床证据的糖尿病移植候选人应进行广泛的血管评估，包括负荷铊心肌成像和/或冠状动脉造影。这些受者应接受仔细的术前咨询，了解其后续动脉疾病的过度风险。
Objective To identify clinical characteristics of diabetic end-stage renal disease patients that place individual transplant candidates at high risk for arterial morbidity and mortality after transplantation. Research Design and Methods We studied the course of 101 sequential renal allograft recipients with insulin-dependent diabetes mellitus, transplanted between 10 November 1980 and 1 April 1986. Arterial disorders were tabulated from medical records and interviews with individual patients, their families, and their private physicians. Documentation of discrete arterial events included recorded physical examinations, radiographic studies, laboratory data, electrocardiograms, peripheral vascular flow studies, and operative reports. The prevalence of preoperative arterial disease was compared with the occurrence of new arterial events after kidney transplantation. Results Within a mean follow-up period of 47 mo, a 30% absolute mortality rate was observed. Of these deaths, 57% resulted from arterial disorders. Clinical manifestations of arterial disease were recognized in 41% of recipients before transplantation, and 78% of these patients suffered new vascular events after transplantation. Of the entire sample, 57% developed at least one new complication of arterial disease after transplantation, whereas only 34% had no vascular diagnosis before or after transplantation. Cerebral, coronary, and peripheral arterial complications after transplantation occurred in 14, 28, and 36% of the patients, respectively. The corresponding incidences of stroke, myocardial infarction, and amputation were 12, 14, and 25%. Pretransplant coronary artery disease predisposed to new coronary eventsafter transplantation, but only peripheral arterial complications occurred more often after transplantation compared with the preoperative period. The probability of arterial complications or death correlated with patient age at first transplant and duration of diabetes but not with sex or smoking history. Conclusions Intrinsic arterial disease in diabetic renal allograft recipients contributes heavily to the long-term morbidity and mortality after transplantation and poses the major threat to survival. Diabetic transplant candidates >35 yr of age or with clincial evidence of arterial disease should undergo an extensive vascular assessment, including stress thallium myocardial imaging and/or coronary arteriography. Such recipients should receive careful preoperative counseling about their excess risk for subsequent arterial disorders.