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. 2021 Oct;21(10):3333-3345.
doi: 10.1111/ajt.16605. Epub 2021 May 20.

Ambient air pollution and posttransplant outcomes among kidney transplant recipients

Yijing Feng  1 , Miranda R Jones  2 , JiYoon B Ahn  1 , Jacqueline M Garonzik-Wang  1 , Dorry L Segev  1   2 , Mara McAdams-DeMarco  1   2
Affiliations

Ambient air pollution and posttransplant outcomes among kidney transplant recipients

Yijing Feng et al. Am J Transplant. 2021 Oct.

Abstract

Fine particulate matter (PM2.5 ), a common form of air pollution which can induce systemic inflammatory response, is a risk factor for adverse health outcomes. Kidney transplant (KT) recipients are likely vulnerable to PM2.5 due to comorbidity and chronic immunosuppression. We sought to quantify the association between PM2.5 and post-KT outcomes. For adult KT recipients (1/1/2010-12/31/2016) in the Scientific Registry of Transplant Recipients, we estimated annual zip-code level PM2.5 concentrations at the time of KT using NASA's SEDAC Global PM2.5 Grids. We determined the associations between PM2.5 and delayed graft function (DGF) and 1-year acute rejection using logistic regression and death-censored graft failure (DCGF) and mortality using Cox proportional hazard models. All models were adjusted for sociodemographics, recipient, transplant, and ZIP code level confounders. Among 87 233 KT recipients, PM2.5 was associated with increased odds of DGF (OR = 1.59; 95% CI: 1.48-1.71) and 1-year acute rejection (OR = 1.31; 95% CI: 1.17-1.46) and increased risk of all-cause mortality (HR = 1.15; 95% CI: 1.07-1.23) but not DCGF (HR = 1.05; 95% CI: 0.97-1.51). In conclusion, PM2.5 was associated with higher odds of DGF and 1-year acute rejection and elevated risk of mortality among KT recipients. Our study highlights the importance of considering environmental exposure as risk factors for post-KT outcomes.

Keywords: clinical research/practice; health services and outcomes research; kidney transplantation/nephrology; patient survival; registry/registry analysis.

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Conflict of interest statement

DISCLOSURE

The authors of this manuscript have conflicts of interest to disclose as described by the American Journal of Transplantation. Dorry L. Segev holds speaking honoraria from Sanofi, Novartis, and CSL Behring. The other authors have no conflicts of interest to disclose.

Figures

Figure 1.
Figure 1.
Dose-response association between ambient air pollution (PM2.5 level) and post-transplant outcomes (a. delayed graft function; b. 1-year acute rejection; c. death-censored graft failure; d. all-cause mortality) among kidney transplant recipients (2010–2016) in the US using restricted-cubic spline function. Model adjusted for demographics (age at transplant, sex, race/ethnicity), education, insurance, health factors (BMI, primary cause of renal failure, year on dialysis, smoking status at transplant listing), transplant factors (cold ischemia time, HLA mismatches, donor type, donor age, donor diabetes, donor hypertension) and ZIP code-level factors [factors percent Black, percent Hispanics/Latino, median household income, monthly house cost, percent below 200% federal poverty line (FPL)]. PM2.5 was centered at the lowest 1% (3.2μg/m3), figure restricted to PM2.5 level between 1% and 99%
Figure 2.
Figure 2.
Ambient air pollution (PM2.5 level) and delayed graft function (DGF) among subgroups of kidney transplant recipients (2010–2016) in the US (N=87,223) CIT: Cold ischemia time; model adjusted for demographics, education, insurance, recipient factors (BMI, primary cause of renal failure, year on dialysis, smoking status at transplant listing), transplant factors (cold ischemia time, HLA mismatches, donor type, donor age, donor diabetes, donor hypertension) and ZIP code-level factors [factors percent Black, percent Hispanics/Latino, median household income, monthly house cost, percent below 200% federal poverty line (FPL)]
Figure 3.
Figure 3.
Ambient air pollution (PM2.5 level) and 1-year acute rejection among subgroups of kidney transplant recipients (2010–2016) in the US (N=83,669) CIT: Cold ischemia time; model adjusted for demographics, education, insurance, recipient factors (BMI, primary cause of renal failure, year on dialysis, smoking status at transplant listing), transplant factors (cold ischemia time, HLA mismatches, donor type, donor age, donor diabetes, donor hypertension) and ZIP code-level factors [factors percent Black, percent Hispanics/Latino, median household income, monthly house cost, percent below 200% federal poverty line (FPL)]
Figure 4.
Figure 4.
Ambient air pollution (PM2.5 level) and death-censored graft failure (DCGF) among subgroups of kidney transplant recipients (2010–2016) in the US (N=87,223) CIT: Cold ischemia time; model adjusted for demographics, education, insurance, recipient factors (BMI, primary cause of renal failure, year on dialysis, smoking status at transplant listing), transplant factors (cold ischemia time, HLA mismatches, donor type, donor age, donor diabetes, donor hypertension) and ZIP code-level factors [percent Black, percent Hispanics/Latino, median household income, monthly house cost, percent below 200% federal poverty line (FPL)]
Figure 5.
Figure 5.
Ambient air pollution (PM2.5 level) and all-cause mortality among subgroups of kidney transplant recipients (2010–2016) in the US (N=87,223) CIT: Cold ischemia time; model adjusted for demographics, education, insurance, recipient factors (BMI, primary cause of renal failure, year on dialysis, smoking status at transplant listing), transplant factors (cold ischemia time, HLA mismatches, donor type, donor age, donor diabetes, donor hypertension) and ZIP code-level factors [percent Black, percent Hispanics/Latino, median household income, monthly house cost, percent below 200% federal poverty line (FPL)]
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