解放军医学杂志2024，Vol.49Issue(4)：371-379,9.DOI:10.11855/j.issn.0577-7402.0296.2024.0126
2型糖尿病合并终末期肾病患者同期胰肾联合移植术后危险因素:UNOS数据库50230例分析
Risk factors for simultaneous pancreas-kidney transplantation in patients with type 2 diabetes complicated by end-stage renal disease:analysis of 50 230 cases from the UNOS database
摘要
Abstract
Objective To compare the outcomes of transplant kidneys and patient survival between simultaneous pancreas-kidney transplantation(SPKT)recipients and deceased donor kidney transplant(DDKT)recipients in patients with type 2 diabetes mellitus(T2DM)complicated with end-stage renal disease(ESRD),and to analyze the risk factors affecting patient survival post-SPKT.Methods Clinical and prognostic data of patients who underwent kidney transplantation from January 27,2003,to January 1,2021,were retrieved from the United Network for Organ Sharing(UNOS)database.A total of 50 230 cases were selected based on inclusion criteria,with 48 669 cases in DDKT group and 1561 cases in SPKT group.Kaplan-Meier analysis was employed to compare transplant kidney and patient survival between the two groups,and propensity score matching(PSM)was utilized to balance confounding factors between the groups.Cox regression model was used to analyze independent risk factors affecting patient survival post-SPKT.Results Compared with DDKT group,recipients in SPKT group had a younger median age(P<0.001),a higher proportion of males(P<0.001),lower BMI(P<0.001),shorter dialysis and transplant waiting times(P<0.001),a higher percentage of private medical insurance(P<0.001),a lower proportion of previous transplants(P<0.001),a younger age at diabetes diagnosis(P<0.001),and a lower incidence of peripheral vascular disease(P=0.033).Compared with DDKT group,the donors in SPKT group had a younger median age(P<0.001),a higher proportion of males(P<0.001),lower BMI(P<0.001),and a lower prevalence of hypertension and diabetes history(P<0.001).In terms of transplant-related factors,the SPKT group had a shorter donor kidney cold ischemia time(P<0.001),a higher degree of HLA mismatch(P<0.001),and a lower Kidney Donor Profile Index(KDPI)(P<0.001)when compared with DDKT group.The SPKT group had lower serum creatinine levels at discharge(P<0.001),lower rates of postoperative delayed graft function(DGF)and acute rejection(AR)(P<0.001),but longer hospital stays(P<0.001)when compared with DDKT group.Kaplan-Meier survival analysis curves,both original and after propensity score matching(PSM),consistently showed significantly higher transplant kidney and patient survival rates in SPKT group compared with DDKT group(P<0.001).Cox regression model analysis indicated that recipient age,recipient race,donor age,and donor kidney cold ischemia time were independent risk factors influencing patient survival post-SPKT.Conclusions For ESRD patients with T2DM,SPKT offers improved long-term graft and patient survival rates compared with DDKT.Recipient age,recipient ethnicity,donor age,and cold ischemia time for the donor's kidney are independent risk factors affecting post-SPKT patient survival.关键词
肾移植/同期胰肾联合移植/倾向性评分匹配/生存分析/预后因素Key words
kidney transplant/simultaneous pancreas-kidney transplant/propensity score matching/survival analysis/prognostic factors分类
医药卫生引用本文复制引用
夏新泽,赖文辉,黄帅,安哲昆,郝晓伟,吕凯凯,罗振君,袁清,蔡明..2型糖尿病合并终末期肾病患者同期胰肾联合移植术后危险因素:UNOS数据库50230例分析[J].解放军医学杂志,2024,49(4):371-379,9.基金项目
This work was supported by the National Natural Science Foundation of China(81770745),and the National Key Research and Development Program of China(2021YFC2009300,2021YFC2009304,2022YFC3602905) 国家自然科学基金(81770745) （81770745）
国家重点研发计划项目(2021YFC2009300,2021YFC2009304,2022YFC3602905) （2021YFC2009300,2021YFC2009304,2022YFC3602905）
