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Impact of comorbidity on outcome in kidney transplant recipients: a retrospective study in Italy

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Abstract

The aim of this study was to relate in-hospital mortality (IHM), cardiovascular events (CVEs) and non-immunologic comorbidity evaluated on the basis of International Classification of Diseases, 9th Revision, Clinical Modification (ICD-9-CM) codification, in Italian kidney transplant recipients (KTRs). We evaluated IHM and admissions due to CVEs between 2000 and 2013 recorded in the database of the region Emilia Romagna. The Elixhauser score was calculated for evaluation of non-immunologic comorbidity. Three main outcomes (i.e. IHM, admission due to major CVEs and combined outcome) were the dependent variables of the multivariate models, while age, gender and Elixhauser score were the independent ones. During the examined period, a total of 9063 admissions in 3648 KTRs were recorded; 1945 patients were males (53.3 %) and 1703 females (46.7 %) and the mean age was 52.9 ± 13.1 years. The non-immunological impaired status of the KTRs, examined by the Elixhauser score, was 3.88 ± 4.29. During the 14-year follow-up period, IHM for any cause was 3.2 % (n = 117), and admissions due to CVEs were 527 (5.8 %). Age and comorbidity were independently associated with CVEs, IHM and the combined outcome. Male gender was independently associated with IHM and combined outcome, but not with CVEs. Evaluation of non-immunological comorbidity is important in KTRs and identification of high-risk patients for major clinical events could improve outcome. Moreover, comorbidity could be even more important in chronic kidney disease patients who are waiting for a kidney transplant.

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Acknowledgments

We thank Franco Guerzoni and Nicola Napoli, Center for Health Statistics, Hospital of Ferrara, for their precious and valuable collaboration. This work has been supported, in part, by a research grant from the University of Ferrara (Fondo Ateneo Ricerca—FAR).

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Authors and Affiliations

  1. Clinica Medica Unit, Department of Medical Sciences, School of Medicine, University of Ferrara, Via L. Ariosto 25, 44121, Ferrara, Italy

    Fabio Fabbian, Alfredo De Giorgi & Roberto Manfredini

  2. Department of Biomedical Sciences and Surgical Specialties, School of Medicine, University of Ferrara, Ferrara, Italy

    Fabio Manfredini & Nicola Lamberti

  3. Nephrology Unit, Department of Specialistic Medicine, University Hospital of Ferrara, Ferrara, Italy

    Silvia Forcellini & Alda Storari

  4. Department of Internal Medicine, University Hospital of Ferrara, Ferrara, Italy

    Massimo Gallerani

  5. Department of Specialistic, Diagnostic and Experimental Medicine, School of Medicine, University of Bologna, Bologna, Italy

    Paola Todeschini & Gaetano La Manna

  6. Department of Clinical Biochemistry (Vascular Disease Prevention Clinic), University College London (UCL) Medical School, London, UK

    Dimitri P. Mikhailidis

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  1. Fabio Fabbian
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  2. Alfredo De Giorgi
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  3. Fabio Manfredini
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  4. Nicola Lamberti
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  9. Gaetano La Manna
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  10. Dimitri P. Mikhailidis
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  11. Roberto Manfredini
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Correspondence to Fabio Fabbian.

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Conflict of interest

F. Fabbian, A. De Giorgi, F. Manfredini, N. Lamberti, S. Forcellini, A. Storari, P. Todeschini, M. Gallerani, G. La Manna, R. Manfredini, had no conflict of interest; D. P. Mikhailidis has given talks, attended conferences and participated in advisory boards and trials sponsored by Merck, Sharp & Dohme, AstraZeneca and Libytec. Authors declare that there are not any potential conflicts of interests that are directly or indirectly related to the data presented in the paper.

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Fabbian, F., De Giorgi, A., Manfredini, F. et al. Impact of comorbidity on outcome in kidney transplant recipients: a retrospective study in Italy. Intern Emerg Med 11, 825–832 (2016). https://doi.org/10.1007/s11739-016-1438-2

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  • DOI: https://doi.org/10.1007/s11739-016-1438-2

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