RISK-FACTORS FOR CHRONIC REJECTION IN RENAL-ALLOGRAFT RECIPIENTS
RISK-FACTORS FOR CHRONIC REJECTION IN RENAL-ALLOGRAFT RECIPIENTS
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DOI：
10.1097/00007890-199304000-00013
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发表时间：
1993-04-01
期刊：
影响因子：
6.2
通讯作者：
SCHAFFER
中科院分区：
文献类型：
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作者：
ALMOND, PS;MATAS, A;SCHAFFER
慢性排斥反应是同种异体肾移植物长期存活的主要障碍。环孢菌素虽然可以有效减少急性排斥反应造成的移植物损失，但对慢性排斥反应的发生率几乎没有影响。 1986年6月2日至1991年1月22日期间，进行了587例单纯肾移植（566例患者），并已输入我们的肾移植数据库并进行了至少1年的随访：103例经活检证实有慢性排斥反应（37例活体相关供体，66例尸体）和484例无慢性排斥反应（236例LRD，248例CAD）。经活检证实有慢性排斥反应的受者的 5 年患者生存率为 84%，而没有经活检证实为慢性排斥反应的受者的 5 年生存率为 89% (P=.08)。经活检证实有慢性排斥反应的受者的 5 年移植物存活率为 31%，而没有活检证实为慢性排斥反应的受者的 5 年移植物存活率为 81% (P < .0001)。通过多变量分析，我们确定了这些变量对慢性排斥反应发生率的影响：移植次数、移植时年龄（50 岁）、性别、人类白细胞抗原匹配、峰值和移植反应性抗体、急性排斥反应、感染（包括巨细胞病毒、病毒和细菌）、供体年龄和 1 年 CsA 剂量（
Chronic rejection is a major barrier to long-term renal allograft survival. Cyclosporine, though effective at reducing graft loss to acute rejection, has had little impact on the incidence of chronic rejection. Between June 2, 1986 and January 22, 1991, 587 kidney-alone transplants (566 patients) were performed, and had been entered into our renal transplant database and had at least 1 year of follow-up: 103 with biopsy-proven chronic rejection (37 living-related donor, 66 cadaver) and 484 without chronic rejection (236 LRD, 248 CAD). The 5-year patient survival was 84% for recipients with biopsy-proven chronic rejection vs. 89% without (P=.08). The 5-year graft survival was 31% for recipients with biopsy-proven chronic rejection vs. 81% without (P < .0001). Using multivariate analysis, we determined the impact on the incidence of chronic rejection of these variables: transplant number, age at transplant (50 years), gender, human leukocyte antigen matching, peak and transplant panel reactive antibody, acute rejection episodes, infections (including cytomegalovirus, viral, and bacterial), donor age, and CsA dosage at 1 year (