排斥反应发作时间对活体供肾移植患者心血管事件的影响：一项多中心回顾性研究。
Impact of timing of rejection episode on cardiovascular events in living donor kidney transplantation: a multicenter retrospective study.
机构信息
Department of Urology, Hirosaki University School of Medicine, 5 Zaifu-Cho, Hirosaki, Aomori, 036-8562, Japan.
Department of Urology, Iwate Medical University, 1-1-1 Idaidori, Yahaba-Cho, Shiwa-Gun, Morioka, Iwate, 028-3694, Japan.
出版信息
J Nephrol. 2023 Dec;36(9):2613-2620. doi: 10.1007/s40620-023-01811-9. Epub 2023 Nov 8.
BACKGROUND
Cardiovascular diseases are still highly prevalent after kidney transplantation. However, little is known about the impact of the timing of rejection episodes on cardiovascular disease. The study aimed to analyze the influence of the timing of rejection episodes on cardiovascular events in recipients of living donor kidney transplantation.
METHODS
We studied 572 living donor kidney transplant recipients from the Michinoku Renal Transplant Network (MRTN), which includes 6 centers in the Tohoku region of Japan. Fine-Gray proportional hazards regression analysis with time-dependent variables was used to assess the effect of rejection episode on cardiovascular events. Recipients were divided into three groups: those without rejection (non-rejection, 370 patients), rejection within 6 months after transplantation (early rejection, 99 patients), and rejection after 6 months (late rejection, 103 patients). The effect of timing on cardiovascular events was evaluated using Fine-Gray proportional hazards regression analysis.
RESULTS
During a median follow-up of 77 months, 70 patients experienced cardiovascular events. Rejection episodes were significantly associated with cardiovascular events (hazard ratio [HR]: 2.08, 95% confidence interval [CI]: 1.26-3.43, P = 0.004), along with age and dialysis vintage. The 5-year cumulative incidence of cardiovascular events was significantly higher in the late rejection group than in the early rejection group (15% vs. 3.3%, P = 0.021). However, no significant difference in 5-year cumulative cardiovascular event incidence was observed between the early rejection and non-rejection groups. Late rejection was significantly associated with cardiovascular events (HR: 2.40, 95% CI: 1.38-4.18, P = 0.002), whereas early rejection was not significantly correlated with cardiovascular event risk (HR: 1.18, P = 0.670).
CONCLUSIONS
Rejections occurring more than 6 months after transplantation is significantly associated with risk of cardiovascular events.
TRIAL REGISTRATION NUMBER
2019-099-1, date of registration; 3 Dec. 2019, retrospectively registered.
背景
肾移植后心血管疾病仍然高发。然而，关于排斥反应发作时间对心血管疾病的影响知之甚少。本研究旨在分析肾移植受者排斥反应发作时间对心血管事件的影响。
方法
我们研究了来自日本东北地区的 6 个中心组成的北日本肾移植网络（MRTN）的 572 例活体供肾移植受者。使用具有时间依赖性变量的 Fine-Gray 比例风险回归分析评估排斥反应对心血管事件的影响。受者分为三组：无排斥组（370 例）、移植后 6 个月内发生排斥组（99 例）和 6 个月后发生排斥组（103 例）。使用 Fine-Gray 比例风险回归分析评估时间对心血管事件的影响。
结果
在中位随访 77 个月期间，70 例患者发生心血管事件。排斥反应与心血管事件显著相关（风险比[HR]：2.08，95%置信区间[CI]：1.26-3.43，P=0.004），同时与年龄和透析年限相关。晚期排斥组的心血管事件 5 年累积发生率明显高于早期排斥组（15%比 3.3%，P=0.021）。然而，早期排斥组和无排斥组的 5 年心血管事件累积发生率无显著差异。晚期排斥与心血管事件显著相关（HR：2.40，95%CI：1.38-4.18，P=0.002），而早期排斥与心血管事件风险无显著相关性（HR：1.18，P=0.670）。
结论
移植后 6 个月以上发生的排斥反应与心血管事件风险显著相关。
试验注册号
2019-099-1，登记日期：2019 年 12 月 3 日，回顾性注册。
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