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논문분류	춘계학술대회 초록집
제목	The Impact of Greenness on Graft Outcomes and Mortality in Kidney Transplant Recipients: A Longitudinal Study from South Korea
저자	Soie Kwon
출판정보	2024; 2024(1):
키워드
초록	Objectives: Recent studies are expanding their focus from internal to external determinants of disease, specifically examining the role of environmental factors. There's a growing interest in the role of green spaces, referred as “Greenness”, moving beyond the well-documented effects of air pollution. Studies notably reveal that higher greenness positively affects chronic kidney disease patients. However, the impact of greenness on kidney transplant recipients (KTRs) remains underexplored. We aim to fill this gap by analyzing the effect of greenness on KTRs, specifically in terms of death-censored graft failure (DCGF) and all-cause mortality. Methods: The study population consisted of KTRs from three tertiary referral centers in South Korea, followed up for more than one year (n=5,266). Greenness was assessed using the annual average Enhanced Vegetation Index (EVI) based on the residential ZIP codes of participants. Time-varying Cox analysis was used to account for changes in EVI during the follow-up period. Results: During the median follow-up of 72 months for DCGF and 80 months for all-cause mortality, graft failure occurred in 425 patients, and 388 patients died. At the time of transplantation, the average age was 46.4 ± 11.9 years, with 25.5% of patients having diabetes and 85.7% having hypertension before the transplant. 75.5% was living kidney transplantation and 15.1% was ABO incompatible kidney transplantation. The adjusted hazard ratio (aHR) indicated that increased greenness was associated with improved graft outcomes and reduced all-cause mortality, particularly in patients older than 40 years. In particular, the increase in greenness showed the most significant benefits for graft outcomes in patients over 60 years of age. As the follow-up period lengthened, the benefits of greenness on graft survival increased, but its advantages regarding all-cause mortality decreased. (Table 1) Conclusions: Our findings suggest that higher residential greenness is associated with improved graft outcomes and lower all-cause mortality in KTRs.
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