Mediation analysis identifies causal factors that lead to increased rates of kidney transplant failure in patients with peripheral vascular disease

IF 2.7 3区医学 Q1 SURGERY American journal of surgery Pub Date : 2025-03-01 Epub Date: 2025-01-07 DOI:10.1016/j.amjsurg.2025.116190

Johnathan Torikashvili , Melissa A. Kendall , Tyler Zander , Rajavi Parikh , Paul C. Kuo , Emily A. Grimsley

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Abstract

Background

This study aims to identify causal mediators of one-year kidney transplant failure in patients with peripheral vascular disease.

Methods

Standard Transplant Analysis and Research database was queried for adults who underwent kidney transplantation from 1987 to 2021. Multi-organ transplant, prior transplant, and living donor kidneys were excluded. Causal mediation analysis with 2000 percentile bootstrapping interactions identified mediators of one-year kidney transplant failure.

Results

212,259 patients were included: 16,215 with and 196,044 without peripheral vascular disease. Causal mediators of one-year kidney transplant failure are Kidney Donor Profile Index (proportionate mediation [PM] 17 %, p < 0.01, E-value = 1.20), pre-transplant dialysis (PM 19 %, p < 0.001, E-value = 1.17), recipient total serum albumin (PM 2 %, p = 0.003, E-value = 1.05), and donor hypertension (PM 1 %, p = 0.017, E-value = 1.04).

Conclusions

Several causal mediators increase rates of one-year kidney transplant failure in patients with peripheral vascular disease. Understanding these mediators can improve pre-transplant assessments and post-transplant outcomes.

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中介分析确定了导致周围血管疾病患者肾移植失败率增加的原因因素。

背景：本研究旨在确定周围血管疾病患者一年肾移植失败的因果介质。方法：对1987年至2021年接受肾移植的成人进行标准移植分析和研究数据库的查询。排除多器官移植、既往移植和活体供体肾脏。用2000个百分位自举相互作用的因果中介分析确定了一年肾移植失败的中介。结果：共纳入212,259例患者，其中有周围血管疾病16,215例，无周围血管疾病196,044例。1年肾移植失败的因果介质是肾供体概况指数（比例介质[PM] 17%， p）。结论：几种因果介质增加了周围血管疾病患者1年肾移植失败的发生率。了解这些介质可以改善移植前评估和移植后结果。

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 surgery 医学-外科

CiteScore

5.00

自引率

6.70%

发文量

570

审稿时长

56 days

期刊介绍： The American Journal of Surgery® is a peer-reviewed journal designed for the general surgeon who performs abdominal, cancer, vascular, head and neck, breast, colorectal, and other forms of surgery. AJS is the official journal of 7 major surgical societies* and publishes their official papers as well as independently submitted clinical studies, editorials, reviews, brief reports, correspondence and book reviews.