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首页> 外文期刊>Journal of the American Society of Nephrology: JASN >Relationship between eGFR Decline and Hard Outcomes after Kidney Transplants
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Relationship between eGFR Decline and Hard Outcomes after Kidney Transplants

机译：肾移植后eGFR下降与硬结局的关系

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Trials designed to assess the effect of interventions on death and graft failure in kidney transplant recipients are not feasible, because these are predominantly late events. Here, we examined the potential of percentage decline in eGFR as a surrogate for hard outcomes. We obtained deidentified data from the Australia and New Zealand Dialysis and Transplant Registry and studied 7949 transplants performed from 1995 to 2009, including 71,845 patient-years of follow-up, 1121 graft losses, and 1192 deaths. We used adjusted Cox proportional hazards models to determine risks of death or death–censored graft failure related to percentage change in eGFR between years 1 and 3 after transplant. Percentage change in eGFR was modeled as a restricted cubic spline. Rate of eGFR decline associated with exponentially increased risks of graft failure and death. Compared with stable eGFR, a ≥30% decline in eGFR, detected in 10% of patients, strongly associated with subsequent death (hazard ratio, 2.20; 95% confidence interval, 1.87 to 2.60) and death–censored graft failure (hazard ratio, 5.14; 95% confidence interval, 4.44 to 5.95). Decline in eGFR was superior to other surrogates, including acute rejection, doubling of serum creatinine level, and eGFR at year 1 or year 2. We conclude that 30% decline in eGFR between years 1 and 3 after kidney transplant is common and strongly associated with risks of subsequent death and death–censored graft failure, which mirrors findings in CKD. Percentage decline in eGFR should be considered for use as a surrogate outcome in kidney transplant trials.
机译：设计用于评估干预对肾移植接受者死亡和移植失败的影响的试验是不可行的，因为这些试验主要是晚期事件。在这里，我们研究了eGFR百分比下降作为替代硬结局的可能性。我们从澳大利亚和新西兰透析与移植登记处获得了身份不明的数据，并研究了1995年至2009年间进行的7949例移植手术，包括71845患者-年的随访，1121例移植物丢失和1192例死亡。我们使用调整后的Cox比例风险模型确定与移植后1年至3年之间eGFR百分比变化相关的死亡风险或以死亡检查的移植物衰竭风险。 eGFR的百分比变化建模为受限三次样条。 eGFR下降的速率与移植失败和死亡的风险呈指数增加有关。与稳定的eGFR相比，在10％的患者中eGFR下降≥30％，与随后的死亡（危险比，2.20; 95％置信区间，1.87至​​2.60）和以死亡检查的移植失败（危险比， 5.14; 95％置信区间，4.44至5.95）。 eGFR的下降优于其他替代物，包括急性排斥反应，血清肌酐水平加倍和在第1年或第2年时的eGFR。我们得出结论，肾脏移植后第1年和第3年之间eGFR下降30％是普遍现象，并且与随后死亡和以死亡检查的移植失败的风险，这反映了CKD的发现。 eGFR的百分比下降应考虑用作肾脏移植试验的替代结果。

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