The influence of clinical, environmental, and socioeconomic factors on five-year patient survival after kidney transplantation

ABSTRACT Introduction: The risk of death after kidney transplant is associated with the age of the recipient, presence of comorbidities, socioeconomic status, local environmental characteristics and access to health care. Objective: To investigate the causes and risk factors associated with death during the first 5 years after kidney transplantation. Methods: This was a single-center, retrospective, matched case-control study. Results: Using a consecutive cohort of 1,873 kidney transplant recipients from January 1st 2007 to December 31st 2009, there were 162 deaths (case group), corresponding to 5-year patient survival of 91.4%. Of these deaths, 25% occurred during the first 3 months after transplant. The most prevalent cause of death was infectious (53%) followed by cardiovascular (24%). Risk factors associated with death were history of diabetes, dialysis type and time, unemployment, delayed graft function, number of visits to center, number of hospitalizations, and duration of hospital stay. After multivariate analysis, only time on dialysis, number of visits to center, and days in hospital were still associated with death. Patients who died had a non-significant higher number of treated acute rejection episodes (38% vs. 29%, p = 0.078), higher mean number of adverse events per patient (5.1 ± 3.8 vs. 3.8 ± 2.9, p = 0.194), and lower mean eGFR at 3 months (50.8 ± 25.1 vs. 56.7 ± 20.7, p = 0.137) and 48 months (45.9 ± 23.8 vs. 58.5 ± 20.2, p = 0.368). Conclusion: This analysis confirmed that in this population, infection is the leading cause of mortality over the first 5 years after kidney transplantation. Several demographic and socioeconomic risk factors were associated with death, most of which are not readily modifiable.

摘要
引言：肾移植术后死亡风险与受者年龄、合并症存在情况、社会经济地位、当地环境特征及医疗服务可及性密切相关。
研究目的：探讨肾移植术后前5年内死亡的相关病因与危险因素。
研究方法：本研究为单中心回顾性匹配病例对照研究。
研究结果：本研究纳入2007年1月1日至2009年12月31日期间的1873例连续性肾移植受者队列，其中162例纳入死亡病例组，对应5年患者生存率为91.4%。该类死亡病例中，25%发生于移植术后前3个月。最常见的死亡病因依次为感染性病因（53%），其次为心血管病因（24%）。与死亡相关的危险因素包括糖尿病病史、透析方式与透析时长、失业状态、移植物功能延迟恢复、就诊中心次数、住院次数及住院总时长。经多因素分析后，仅透析时长、就诊中心次数及住院天数仍与死亡存在显著关联。死亡患者的治疗性急性排斥反应发作占比虽无统计学显著性升高（38% vs. 29%，p=0.078），人均不良事件平均数量更高（5.1 ± 3.8 vs. 3.8 ± 2.9，p=0.194），且术后3个月（50.8 ± 25.1 vs. 56.7 ± 20.7，p=0.137）及48个月（45.9 ± 23.8 vs. 58.5 ± 20.2，p=0.368）的平均估算肾小球滤过率（estimated glomerular filtration rate, eGFR）更低。
结论：本分析证实，在该研究人群中，感染是肾移植术后前5年的首要死亡病因。多项人口统计学与社会经济相关危险因素与死亡相关，其中多数难以通过临床干预进行改善。