Abstract：
Kidney transplant recipients are at an increased risk of fractures, and targeted preventive strategies are needed. Therefore, in this retrospective cohort study, we investigated a large population-based cohort to identify the transplant recipient-specific risk factors for fractures in Taiwanese kidney transplant recipients.
We conducted a retrospective cohort study using the National Health Insurance Research Database. Patients who underwent renal transplantation between 2003 and 2015 were identified and followed until December 31, 2015, to observe the development of fractures. Variables associated with the development of post-transplant fractures were identified by calculating hazard ratios in a Cox regression model.
5,309 renal transplant recipients were identified, of whom 553 (10.4%) were diagnosed with post-transplant fractures. Independent predictors of post-transplant fractures included an age at transplant ≥65 years (p < 0.001), female sex (p < 0.001), fractures within 3 years prior to transplantation (p < 0.001), and diabetes mellitus (p < 0.001). In addition, daily prednisolone doses >2.9–5.3 mg/day (p < 0.001), >5.3–8.7 mg/day (p < 0.001), and >8.7 mg/day (p < 0.001) were also independent predictors of post-transplant fractures. Conversely, the use of peritoneal dialysis before renal transplantation (p = 0.021), hypertension (p = 0.005), and the use of tacrolimus (p < 0.001), azathioprine (p = 0.006), mycophenolate mofetil/mycophenolic acid (p = 0.002), mTOR inhibitors (p = 0.004), and calcium supplements (p = 0.009) were inversely correlated with post-transplant fractures.
We recommend minimizing daily glucocorticoids as early and as far as possible in conjunction with immunosuppressive regimens such as tacrolimus, azathioprine, mycophenolate mofetil/mycophenolic acid, mTOR inhibitors, and calcium supplements, especially in older female recipients and in recipients with diabetes and a history of prior fractures.
We conducted a retrospective cohort study using the National Health Insurance Research Database. Patients who underwent renal transplantation between 2003 and 2015 were identified and followed until December 31, 2015, to observe the development of fractures. Variables associated with the development of post-transplant fractures were identified by calculating hazard ratios in a Cox regression model.
5,309 renal transplant recipients were identified, of whom 553 (10.4%) were diagnosed with post-transplant fractures. Independent predictors of post-transplant fractures included an age at transplant ≥65 years (p < 0.001), female sex (p < 0.001), fractures within 3 years prior to transplantation (p < 0.001), and diabetes mellitus (p < 0.001). In addition, daily prednisolone doses >2.9–5.3 mg/day (p < 0.001), >5.3–8.7 mg/day (p < 0.001), and >8.7 mg/day (p < 0.001) were also independent predictors of post-transplant fractures. Conversely, the use of peritoneal dialysis before renal transplantation (p = 0.021), hypertension (p = 0.005), and the use of tacrolimus (p < 0.001), azathioprine (p = 0.006), mycophenolate mofetil/mycophenolic acid (p = 0.002), mTOR inhibitors (p = 0.004), and calcium supplements (p = 0.009) were inversely correlated with post-transplant fractures.
We recommend minimizing daily glucocorticoids as early and as far as possible in conjunction with immunosuppressive regimens such as tacrolimus, azathioprine, mycophenolate mofetil/mycophenolic acid, mTOR inhibitors, and calcium supplements, especially in older female recipients and in recipients with diabetes and a history of prior fractures.
摘要：
背景：肾移植受者骨折的风险增加，需要有针对性的预防策略。因此,在这项回顾性队列研究中，我们调查了一个基于人群的大型队列,以确定台湾肾移植受者中发生骨折的移植受者特异性危险因素.
方法：我们使用国家健康保险研究数据库进行了一项回顾性队列研究。确定了在2003年至2015年之间进行肾移植的患者，并随访至2015年12月31日，以观察骨折的发展。通过计算Cox回归模型中的风险比，确定了与移植后骨折发展相关的变量。
结果：确定了5309名肾移植受者，其中553（10.4%）被诊断为移植后骨折。移植后骨折的独立预测因素包括移植年龄≥65岁（p<0.001），女性（p<0.001），移植前3年内骨折（p<0.001），和糖尿病（p<0.001）。此外,每日泼尼松龙剂量>2.9-5.3mg/天（p<0.001），>5.3-8.7mg/天（p<0.001）和>8.7mg/天（p<0.001）也是移植后骨折的独立预测因子。相反，肾移植前使用腹膜透析（p=0.021），高血压（p=0.005），和他克莫司的使用（p<0.001），硫唑嘌呤（p=0.006），霉酚酸酯/霉酚酸（p=0.002），mTOR抑制剂（p=0.004）和钙补充剂（p=0.009）与移植后骨折呈负相关。
结论：我们建议尽早减少每日糖皮质激素，并尽可能与他克莫司等免疫抑制方案联合使用，硫唑嘌呤，霉酚酸酯/霉酚酸，mTOR抑制剂和钙补充剂，尤其是老年女性接受者，以及患有糖尿病和既往骨折史的接受者。
方法：我们使用国家健康保险研究数据库进行了一项回顾性队列研究。确定了在2003年至2015年之间进行肾移植的患者，并随访至2015年12月31日，以观察骨折的发展。通过计算Cox回归模型中的风险比，确定了与移植后骨折发展相关的变量。
结果：确定了5309名肾移植受者，其中553（10.4%）被诊断为移植后骨折。移植后骨折的独立预测因素包括移植年龄≥65岁（p<0.001），女性（p<0.001），移植前3年内骨折（p<0.001），和糖尿病（p<0.001）。此外,每日泼尼松龙剂量>2.9-5.3mg/天（p<0.001），>5.3-8.7mg/天（p<0.001）和>8.7mg/天（p<0.001）也是移植后骨折的独立预测因子。相反，肾移植前使用腹膜透析（p=0.021），高血压（p=0.005），和他克莫司的使用（p<0.001），硫唑嘌呤（p=0.006），霉酚酸酯/霉酚酸（p=0.002），mTOR抑制剂（p=0.004）和钙补充剂（p=0.009）与移植后骨折呈负相关。
结论：我们建议尽早减少每日糖皮质激素，并尽可能与他克莫司等免疫抑制方案联合使用，硫唑嘌呤，霉酚酸酯/霉酚酸，mTOR抑制剂和钙补充剂，尤其是老年女性接受者，以及患有糖尿病和既往骨折史的接受者。
