Association of delayed graft function with cardiovascular outcomes in kidney transplant recipients

IF 8.2 2区医学 Q1 SURGERY

American Journal of Transplantation Pub Date : 2025-10-01 DOI:10.1016/j.ajt.2025.05.036

Thomas Beaudrey , Estelle Aymes , Olivier Thaunat , Dimitri Bedo , Christophe Masset , Vincent Pernin , Philippe Gatault , Marc Ladrière , Marie-Pascale Morin , Coralie Poulain , Antoine Thierry , Dominique Bertrand , Valérie Chatelet , Laetitia Albano , Yannick Le Meur , Anne Elisabeth Heng , Charlotte Boud’Hors , Jean Philippe Rerolle , Guillaume Claisse , Sophie Caillard , Nans Florens

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引用次数: 0

Abstract

Cardiovascular disease remains a major cause of morbidity and mortality in kidney transplant recipients. This multicenter cohort study examined the association between delayed graft function (DGF) and major adverse cardiovascular events (MACEs) in a cohort of 18 149 kidney transplant recipients from 17 French hospitals, transplanted between 2008 and 2022. The primary outcome measured was the incidence of MACEs, including cardiovascular death, coronary artery disease, heart failure, and stroke, with secondary outcomes of graft failure and noncardiovascular death. Among the cohort, 4182 (23.0%) experienced DGF, which was associated with a significantly increased risk of MACEs (hazard ratio: 1.24, 95% confidence interval: 1.10-1.40), particularly coronary artery disease, heart failure, and cardiovascular death, but not stroke. The association of DGF with an increased MACE incidence remained consistent over time (P-interaction = .19) and intensified with greater DGF severity, as measured by the number of dialysis sessions required after transplantation (P-trend = .01). Graft function did not significantly mediate the association between DGF and MACEs (P = .62). These findings suggest that the renal lesions resulting from DGF may mediate cardiovascular risk, highlighting the need for optimized prevention and treatment strategies to improve patient outcomes.

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肾移植受者移植功能延迟与心血管预后的关系

心血管疾病仍然是肾移植受者发病和死亡的主要原因。这项多中心队列研究对来自法国17家医院的18,149名肾移植受者进行了延迟移植功能（DGF）和主要不良心血管事件（MACE）之间的关系进行了研究，这些肾移植受者在2008年至2022年间进行了移植。测量的主要结局是MACE的发生率，包括心血管死亡、冠状动脉疾病、心力衰竭和中风，次要结局是移植物衰竭和非心血管死亡。在该队列中，4182人（23.0%）经历了DGF，这与MACE风险显著增加相关（HR: 1.24, 95% CI: 1.10-1.40），特别是冠状动脉疾病、心力衰竭和心血管死亡，但与中风无关。随着时间的推移，DGF与MACE发生率增加的相关性保持一致（相互作用p值= 0.19），并且随着DGF严重程度的增加而增强，通过移植后所需的透析次数来测量（趋势p = 0.01）。移植物功能没有介导DGF和MACE之间的关联（p = 0.62）。这些发现表明，DGF引起的肾脏病变可能介导心血管风险，强调需要优化预防和治疗策略以改善患者预后。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

American Journal of Transplantation 医学-外科

CiteScore

18.70

自引率

4.50%

发文量

346

审稿时长

26 days

期刊介绍： The American Journal of Transplantation is a leading journal in the field of transplantation. It serves as a forum for debate and reassessment, an agent of change, and a major platform for promoting understanding, improving results, and advancing science. Published monthly, it provides an essential resource for researchers and clinicians worldwide. The journal publishes original articles, case reports, invited reviews, letters to the editor, critical reviews, news features, consensus documents, and guidelines over 12 issues a year. It covers all major subject areas in transplantation, including thoracic (heart, lung), abdominal (kidney, liver, pancreas, islets), tissue and stem cell transplantation, organ and tissue donation and preservation, tissue injury, repair, inflammation, and aging, histocompatibility, drugs and pharmacology, graft survival, and prevention of graft dysfunction and failure. It also explores ethical and social issues in the field.