Korean J Transplant.  2022 Nov;36(Supple 1):S341. 10.4285/ATW2022.F-4862.

Air pollution and posttransplant outcomes in kidney transplant recipients

• Lim SJ
• Hwang J
• Kwon H
• Ko Y
• Jung J
• Kwon H
• Kim Y
• Kim N
• Shin S

• KMID: 2535568
• DOI: http://doi.org/10.4285/ATW2022.F-4862

Abstract

Background
Elevated ozone levels are associated with increased risk of fatal coronary heart disease in kidney transplant recipi-ents (KTRs). However, there were few studies about the relationship between air pollutants and risk of biopsy-proven acute rejection (BPAR), death-censored graft failure (DCGF) and mortality in KTRs.
Methods
Patients who had kidney transplantation between January 1, 2009, and December 31, 2018 at a single center were followed on a regular basis until June 30, 2020. Patients who had previous kidney transplantation, had positive crossmatching, and multi-organ transplantation were excluded. Primary end-points are BPAR, DCGF and all-cause mortality for up to 5 years. CO, NO ₂ , SO ₂ , O ₃ , and PM ₁₀ concentrations after transplantation were measured at each recipients address using data from Korea meteorological administration. Cox proportional hazard regression models were used to verify contributing factors for primary end-points.
Results
Of the enrolled 2,005 KTRs, 61% were male, the median age at transplantation was 47 years of age. ABO-incompatible and donor-specific antibodies-positive kidney transplantation were 23.4% and 10.5%, respectively. The median concentrations of CO, NO ₂ , SO ₂ , O ₃ and PM ₁₀ were 489 ppb, 23.4 ppb, 4.05 ppb, 25.6 ppb, and 45.1 g/m³ , respectively. During the study period, annual average PM 10 exposure varied ranging from 23.2 to 73.3 g/m ³ . During the study period, there was 238 episodes of BPAR and 72 patients had graft failure. The estimated overall rejection hazard ratio (HR), per 1 g/m³ increment increase in annual PM 10 exposure was 1.01 (95% confidence interval [CI], 0.99–1.04). For each 1-ppb increase in ozone, the HR of 5-year graft failure is 1.06 (95% CI, 1.00–1.11).
Conclusions
There was a weak association between air pollutants and clinical outcomes such as BPAR, DCGF and mortality in KTRs.