Risk of renal allograft loss from recurrent glomerulonephritis
Risk of renal allograft loss from recurrent glomerulonephritis
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DOI：
10.1056/nejmoa013036
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发表时间：
2002-07-11
影响因子：
158.5
通讯作者：
Chadban, SJ
中科院分区：
文献类型：
--
作者：
Briganti, EM;Russ, GR;Chadban, SJ
背景：复发性肾小球肾炎是肾移植失败的一个已知原因，然而，这种并发症的发生率并不明确。我们确定的发病率，时间，和移植物丢失的相对重要性，由于复发的glomerulonephritis.Methods的1505例活检证实的肾小球肾炎患者接受了主肾移植在澳大利亚从1988年至1997年。肾活检证实复发。Kaplan-Meier法用于估计10年因复发性肾小球肾炎导致的同种异体移植物衰竭的发生率，并将该发生率与功能正常的同种异体移植物的急性排斥反应、慢性排斥反应和死亡的发生率进行比较。受体和捐助者的特点进行了检查，作为潜在的预测recurration.Results移植物丢失由于肾小球肾炎复发发生在52个收件人，10年的发病率为8.4%（95%的置信区间，5.9至12.0）。肾小球肾炎的类型、受者的性别和群体反应性抗体的峰值水平是复发风险的独立预测因素。复发是10年时同种异体移植物丢失的第三大常见原因，排在慢性排斥反应和功能正常的同种异体移植物死亡之后。尽管有复发的影响，但在经活检证实的肾小球肾炎和其他原因导致肾衰竭的移植受者中，10年移植物丢失的总发生率相似（45.4%[95%置信区间，40.9至50.2] vs. 45.8%[95%置信区间，42.3结论复发是肾小球肾炎肾功能衰竭患者移植肾失败的重要原因。没有发现需要改变移植方法的复发风险因素。然而，现在可以为潜在的肾移植受者提供准确的风险评估。
Background Recurrent glomerulonephritis is' a known cause of renal allograft loss; however, the incidence of this complication is poorly defined. We determined the incidence, timing, and relative importance of allograft loss due to the recurrence of glomerulonephritis.Methods A total of 1505 patients with biopsy-proved glomerulonephritis received a primary renal transplant in Australia from 1988 through 1997. Recurrence was confirmed by renal biopsy. The Kaplan-Meier method was used to estimate the 10-year incidence of allograft failure due to recurrent glomerulonephritis, and this incidence was compared with the incidence of acute rejection, chronic rejection, and death with a functioning allograft. Characteristics of the recipients and donors were examined as potential predictors of recurrence.Results Allograft loss due to the recurrence of glomerulonephritis occurred in 52 recipients, with a 10-year incidence of 8.4 percent (95 percent confidence interval, 5.9 to 12.0). The type of glomerulonephritis, the sex of the recipient, and the peak level of panel-reactive antibodies were independent predictors of the risk of recurrence. Recurrence was the third most frequent cause of allograft loss at 10 years, after chronic rejection and death with a functioning allograft. Despite the effect of recurrence, the overall 10-year incidence of allograft loss was similar among transplant recipients with biopsy-proved glomerulonephritis and among those with other causes of renal failure (45.4 percent [95 percent confidence interval, 40.9 to 50.2] vs. 45.8 percent [95 percent confidence interval,. 42.3 to 49.3], P=0.09).Conclusions Recurrence is an important cause of allograft loss for those with renal failure due to glomerulonephritis. No risk factors for recurrence were identified that warrant altering the approach to transplantation. However, accurate estimates of risk can now be provided to potential recipients of renal allografts.