Outcome of renal transplantation in adolescents with focal segmental glomerulosclerosis
Outcome of renal transplantation in adolescents with focal segmental glomerulosclerosis
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DOI：
10.1034/j.1399-3046.2002.02036.x
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发表时间：
2002-12-01
影响因子：
1.3
通讯作者：
Alexander, SR
中科院分区：
文献类型：
--
作者：
Baum, MA;Ho, M;Alexander, SR
使用NAPRTCS数据库从1987年1月至2001年1月，我们检查了2687例青少年（年龄13-17岁）的索引肾移植，以分析人口统计学治疗的差异，并与其他肾脏疾病相比，FSGS青少年的结局。338例（12.6%）青少年有FSGS的初步诊断。患有FSGS的青少年更有可能是黑人，并且不太可能接受先发制人的移植（p < 0.001）。HLA配型或免疫抑制方案无差异。与非FSGS青少年相比，LD（11% vs. 4.7%）或CD（25.1% vs. 17.8%）移植后更多FSGS青少年发生急性肾小管坏死（p < 0.001）。FSGS青少年与其他青少年之间的急性排斥反应发生率无显著差异。与非FSGS青少年（77%）相比，LD FSGS青少年（6岁，56%）的移植物存活率更差（p < 0.001），并且与FSGS组（51%）或非FSGS组（61%）的CD移植物存活率无显著差异。与无FSGS的LD移植相比，有FSGS的LD移植的移植失败的相对风险（RR）最大（RR = 1.75; p < 0.001）（RR = 1.0）。原发性疾病复发占FSGS移植青少年移植失败的15.2%，LD（17%）或CD（13.8%）移植物之间没有差异。在没有FSGS的青少年中，复发性疾病占移植失败的3.2%。复发性疾病是两组间移植失败的唯一原因（p < 0.001）。与12岁以下的FSGS患者相比，青少年FSGS患者LD和CD移植的移植物存活率更差（LD p = 0.035，CD p < 0.001）。总之，FSGS对青少年移植物存活率有负面影响。FSGS复发导致青少年患者预期的LD移植物存活优势丧失。此外，与FSGS的年幼儿童相比，FSGS的青少年移植物存活率降低。这些数据表明，在青少年FSGS中进行LD移植的理由应该基于LD移植通常所见的移植物存活率增加以外的因素。
Using the NAPRTCS database from January 1987 to January 2001, we examined 2687 adolescent (age 13-17 yr) index renal transplants to analyze differences in demographic treatment, and outcomes in adolescents with FSGS compared to other renal disease. 338 (12.6%) of adolescents had a primary diagnosis of FSGS. Adolescents with FSGS were more likely to be black and less likely to receive pre-emptive transplants (p < 0.001). No differences existed in HLA matching or immunosuppression regimens. Acute tubular necrosis occurred in more FSGS adolescents compared to non-FSGS adolescents following LD (11% vs. 4.7%) or CD (25.1% vs. 17.8%) transplant (p < 0.001). There were no significant differences in acute rejection rates between adolescents with FSGS and other adolescents. Graft survival was worse for LD FSGS adolescents (6 yr, 56%) compared to non- FSGS adolescents (77%) (p < 0.001) and was not significantly different from CD graft survival in FSGS (51%) or non-FSGS groups (61%). The relative risk (RR) of graft failure was greatest in LD transplant with FSGS (RR = 1.75; p < 0.001), compared to LD transplants without FSGS (RR = 1.0). Recurrent primary disease accounted for 15.2% of all graft failures in adolescents transplanted for FSGS with no difference between LD (17%) or CD (13.8%) grafts. Recurrent disease accounted for 3.2% of graft failures in adolescents without FSGS. Recurrent disease was the only cause of graft failure that differed between groups (p < 0.001). When compared to patients up to age 12 yr with FSGS, graft survival in both LD and CD transplants was worse in adolescents with FSGS (LD p = 0.035, CD p < 0.001). In conclusion, FSGS has a negative impact on graft survival in adolescents. Recurrence of FSGS results in a loss of the expected LD graft survival advantage in adolescents. Furthermore, adolescents with FSGS have decreased graft survival compared to younger children with FSGS. These data suggest that the rationale for LD transplantation in adolescents with FSGS should be based on factors other than the increased graft survival typically seen with LD transplantation.