移植前甲状旁腺功能亢进与肾移植后的移植物或患者预后

F. Rodrigues, W. Y. van der Plas, Camilo G. Sotomayor, A. van der Vaart, D. Kremer, Robert A. Pol, S. Kruijff, I. Heilberg, Stephan J. L. Bakker, M. D. de Borst
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引用次数: 0

摘要

关于移植前甲状旁腺激素(PTH)水平对肾移植后早期或长期肾功能的影响还存在争议。我们评估了严重的甲状旁腺功能亢进是否与移植功能延迟(DGF)、死亡校正移植失败(DCGF)或全因死亡率相关。在这项单中心队列研究中,我们使用多变量逻辑分析和 Cox 回归分析法研究了移植时 PTH 和其他与骨和矿物质代谢相关的参数(包括血清碱性磷酸酶 (ALP))与随后的 DGF、DCGF 和全因死亡率风险之间的关系。在 1576 名肾移植受者(51.6 ± 14.0 岁,57.3% 为男性)中,有 121 名患者存在严重的甲状旁腺功能亢进,其特征是移植前 PTH ≥ 771 pg/mL(>9 倍上限)。在5.2 [0.2-30.0] 年的随访期间,278(15.7%)名患者出现了DGF,150(9.9%)名患者出现了DCGF,432(28.6%)名患者死亡。移植前较高的 PTH 与 DGF(HR 1.06 [0.90-1.25])、DCGF(HR 0.98 [0.87-1.13])或全因死亡率(HR 1.02 [0.93-1.11])无关。敏感性分析的结果一致。与骨和矿物质代谢相关的其他参数(包括 ALP)也是如此。移植前严重的甲状旁腺功能亢进与DGF、DCGF或全因死亡率风险的增加无关,因此不支持在肾移植前进行纠正以提高移植物或患者存活率的必要性。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Pre-Transplant Hyperparathyroidism and Graft or Patient Outcomes After Kidney Transplantation
The impact of pre-transplant parathyroid hormone (PTH) levels on early or long-term kidney function after kidney transplantation is subject of debate. We assessed whether severe hyperparathyroidism is associated with delayed graft function (DGF), death-censored graft failure (DCGF), or all-cause mortality. In this single-center cohort study, we studied the relationship between PTH and other parameters related to bone and mineral metabolism, including serum alkaline phosphatase (ALP) at time of transplantation with the subsequent risk of DGF, DCGF and all-cause mortality using multivariable logistic and Cox regression analyses. In 1,576 kidney transplant recipients (51.6 ± 14.0 years, 57.3% male), severe hyperparathyroidism characterized by pre-transplant PTH ≥771 pg/mL (>9 times the upper limit) was present in 121 patients. During 5.2 [0.2–30.0] years follow-up, 278 (15.7%) patients developed DGF, 150 (9.9%) DCGF and 432 (28.6%) died. A higher pre-transplant PTH was not associated with DGF (HR 1.06 [0.90–1.25]), DCGF (HR 0.98 [0.87–1.13]), or all-cause mortality (HR 1.02 [0.93–1.11]). Results were consistent in sensitivity analyses. The same applied to other parameters related to bone and mineral metabolism, including ALP. Severe pre-transplant hyperparathyroidism was not associated with an increased risk of DGF, DCGF or all-cause mortality, not supporting the need of correction before kidney transplantation to improve graft or patient survival.
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