title: Impact of comorbidity on outcome in kidney transplant recipients: a retrospective study in Italy.
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.
authors.affiliation: Clinica Medica Unit, Department of Medical Sciences, School of Medicine, University of Ferrara, Via L. Ariosto 25, 44121, Ferrara, Italy. f.fabbian@ospfe.it.
authors.forename: Fabio
authors.initials: F
authors.lastname: Fabbian
authors.affiliation: Clinica Medica Unit, Department of Medical Sciences, School of Medicine, University of Ferrara, Via L. Ariosto 25, 44121, Ferrara, Italy.
authors.forename: Alfredo
authors.initials: A
authors.lastname: De Giorgi
authors.affiliation: Department of Biomedical Sciences and Surgical Specialties, School of Medicine, University of Ferrara, Ferrara, Italy.
authors.forename: Fabio
authors.initials: F
authors.lastname: Manfredini
authors.affiliation: Department of Biomedical Sciences and Surgical Specialties, School of Medicine, University of Ferrara, Ferrara, Italy.
authors.forename: Nicola
authors.initials: N
authors.lastname: Lamberti
authors.affiliation: Nephrology Unit, Department of Specialistic Medicine, University Hospital of Ferrara, Ferrara, Italy.
authors.forename: Silvia
authors.initials: S
authors.lastname: Forcellini
authors.affiliation: Nephrology Unit, Department of Specialistic Medicine, University Hospital of Ferrara, Ferrara, Italy.
authors.forename: Alda
authors.initials: A
authors.lastname: Storari
authors.affiliation: Department of Specialistic, Diagnostic and Experimental Medicine, School of Medicine, University of Bologna, Bologna, Italy.
authors.forename: Paola
authors.initials: P
authors.lastname: Todeschini
authors.affiliation: Department of Internal Medicine, University Hospital of Ferrara, Ferrara, Italy.
authors.forename: Massimo
authors.initials: M
authors.lastname: Gallerani
authors.affiliation: Department of Specialistic, Diagnostic and Experimental Medicine, School of Medicine, University of Bologna, Bologna, Italy.
authors.forename: Gaetano
authors.initials: G
authors.lastname: La Manna
authors.affiliation: Department of Clinical Biochemistry (Vascular Disease Prevention Clinic), University College London (UCL) Medical School, London, UK.
authors.forename: Dimitri P
authors.initials: DP
authors.lastname: Mikhailidis
authors.affiliation: Clinica Medica Unit, Department of Medical Sciences, School of Medicine, University of Ferrara, Via L. Ariosto 25, 44121, Ferrara, Italy.
authors.forename: Roberto
authors.initials: R
authors.lastname: Manfredini
mesh_terms: D000328:Adult; D000368:Aged; D002318:Cardiovascular Diseases / Q000453:epidemiology / Q000209:etiology / Q000401:mortality; D015897:Comorbidity; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D007558:Italy / Q000453:epidemiology; D016030:Kidney Transplantation / Q000401:mortality* / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D016896:Treatment Outcome
keywords: Cardiovascular events; Comorbidity; Elixhauser score; ICD-9-CM; In-hospital mortality; Renal transplantation