Absence of deleterious effect on long-term kidney graft survival of rejection episodes with complete functional recovery.
Absence of deleterious effect on long-term kidney graft survival of rejection episodes with complete functional recovery.
复制标题
排斥反应对肾移植物的长期存活没有有害影响，且功能完全恢复。
DOI：
10.1097/00007890-199706270-00006
复制
发表时间：
1997
期刊：
影响因子：
6.2
通讯作者：
P. Kinnaert
中科院分区：
文献类型：
--
作者：
P. Vereerstraeten;D. Abramowicz;L. De Pauw;P. Kinnaert
背景
排异反应（RE）对移植肾的长期预后有不利影响。然而，这些RE的严重程度对移植物存活的影响以及可以预测这种影响的因素尚不明确。本回顾性研究对过去12年在我中心接受582例尸体肾移植的成人患者进行，以评估移植后第一年发生的RE对移植物存活的影响，并揭示与RE严重程度相关的因素。
方法
排斥反应分为三个等级：（1）无移植物功能丧失的排斥反应（良性排斥反应）;（2）移植物功能部分丧失的排斥反应（严重排斥反应）;（3）恢复透析的排斥反应（不可逆排斥反应）。移植物分为四组：（1）无排斥反应的移植物;（2）良性RE（仅1级RE）的移植物;（3）重度RE（一个或多个2级RE）的移植物;和（4）不可逆（3级）RE的移植物。
结果
多因素分析显示：（1）在移植后第一年发生RE（第1组与第2、3和4组）与CsA而不是OKT 3单克隆抗体的原发性免疫抑制、HLA-B + DR错配的数量和年轻受者的年龄显著相关;（2）在排斥反应患者中，不可逆性RE患者（第4组）的OKT 3单克隆抗体预防使用率低于可逆性RE患者（2组，良性，3组，重度）;（3）没有单一因素能够区分良性RE（2组）和重度RE（3组）。对于移植后1年仍有功能的移植物，无RE或良性RE移植物的长期移植物存活率相似，但严重RE移植物的长期移植物存活率明显较低（P<0.0001）：8年存活率分别为89%和60%。1年后移植物存活率的下降与血清肌酐值显著相关，但与1年时环孢素的剂量无关。
结论
良性RE发生在移植后第一年内，不会导致移植物功能丧失，不会对长期肾移植结果产生不利影响。相比之下，在同一时间段内严重RE的移植物预后差得多。
BACKGROUND
Rejection episodes (RE) exert a detrimental influence on long-term kidney graft outcome. However, the impact of the severity of those RE on graft survival and the factors that could predict this impact are ill defined. The present retrospective study was undertaken on adult patients who received 582 cadaver kidney transplants at our center during the last 12 years, to assess the impact on graft survival of RE occurring during the first year after transplantation and to uncover the factors associated with the severity of those RE.
METHODS
Three grades of rejection were defined: (1) rejection without loss of graft function (benign rejection); (2) rejection followed by partial loss of graft function (severe rejection); and (3) rejection with return to dialysis (irreversible rejection). The grafts were distributed among four groups: (1) grafts free of rejection; (2) grafts with benign RE (only grade 1 RE); (3) grafts with severe RE (one or more grade 2 RE); and (4) grafts with irreversible (grade 3) RE.
RESULTS
Multivariate analyses revealed that (1) the occurrence of RE during the first posttransplant year (group 1 versus groups 2, 3, and 4) was significantly associated with primary immunosuppression with CsA rather than with OKT3 monoclonal antibody, the number of HLA-B + DR mismatches, and the younger recipient's age; (2) in patients with rejection, OKT3 monoclonal antibody prophylaxis was less often used in patients with irreversible RE (group 4) than in those with reversible RE (group 2, benign, and group 3, severe); and (3) no single factor was able to differentiate patients with benign RE (group 2) from those with severe RE (group 3). For grafts still functioning 1 year after transplantation, long-term graft survival was similar in grafts with either no RE or benign RE, but it was significantly lower (P<0.0001) in grafts with severe RE: 8-year survival rates were 89% and 60%, respectively. The decline in graft survival after 1 year was significantly correlated with the serum creatinine value but not with the dose of cyclosporine at 1 year.
CONCLUSIONS
Benign RE occurring during the first year after transplantation and resulting in no loss of graft function do not exert a detrimental influence on long-term kidney graft outcome. In contrast, the prognosis of grafts with severe RE during the same period of time is much poorer.
影响因子：
158.5
作者：
BRENNER, BM;MEYER, TW;HOSTETTER, TH
通讯作者：
HOSTETTER, TH
影响因子：
6.2
作者：
ALMOND, PS;MATAS, A;SCHAFFER
通讯作者：
SCHAFFER