Determinants of chronic renal allograft rejection in cyclosporine-treated recipients.
Determinants of chronic renal allograft rejection in cyclosporine-treated recipients.
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环孢素治疗的受者慢性同种异体肾移植排斥的决定因素。
DOI：
10.1097/00007890-199611150-00009
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发表时间：
1996
期刊：
影响因子：
6.2
通讯作者：
A. Novick
中科院分区：
文献类型：
--
作者：
S. Flechner;C. Modlin;D. Serrano;D. Goldfarb;D. Papajcik;B. Mastroianni;M. Goormastic;A. Novick
我们分析了1987年7月至1994年11月间507例患者的511例单肾肾移植术中慢性排斥反应的发生情况。数据库建立了≥ 18岁接受环孢素为基础的免疫抑制，并证明移植物存活至少12个月的受体。347例尸体移植受者（67.9%）和164例活体移植受者（32.1%）随访12至102个月（平均51个月）。在124例移植中诊断出慢性排斥反应（24%），平均诊断时间为23+/-18个月（范围3-92）。采用考克斯模型进行多变量分析，确定风险因素。在单变量模型中分析了排斥事件的时间和严重程度的影响。慢性排斥反应的存在导致尸体移植物（83.7% vs. 58.2%）和活体供体移植物（93.2% vs. 53.1%）受体的5年移植物存活率降低（P=0.0001）。发生慢性排斥反应的重要变量包括急性排斥反应发作（P=0.0001）、黑人受体（P=0.0006）、供体年龄≥ 50岁（P=0.006）和移植后6个月血清肌酐水平>2.0 mg/dl。排斥反应的严重程度通过血清肌酐峰值或治疗后恢复到基线来衡量，与慢性排斥反应无关。然而，急性排斥反应持续5天以上（P=0.03）或6个月后发生（P=0.001）确实影响慢性排斥反应的时间。此外，供体-受体种族不匹配是尸体移植受体的一个显著（P=0.008）风险因素。我们的结论是急性排斥反应是慢性排斥反应的最重要的危险因素，移植物的长期命运可能早在前6个月就已确定。种族匹配的供受者对可能是有用的，以尽量减少慢性排斥反应的风险。减少急性排斥反应发生率和严重程度的未来进展可能对长期生存产生最大影响。
We analyzed the development of chronic rejection in 511 kidney-only renal transplants in 507 patients between July 1987 and November 1994. A database was established for recipients > or = 18 years old who received cyclosporine-based immunosuppression and demonstrated graft survival for a minimum of 12 months. The 347 recipients of cadaver transplants (67.9%) and 164 recipients of live donor transplants (32.1%) were followed for 12 to 102 months (mean 51 months). Chronic rejection was diagnosed in 124 transplants (24%), with a mean time to diagnosis of 23+/-18 months (range 3-92). Risk factors were identified in a multivariate analysis using the Cox model. The impact of the timing and severity of rejection episodes was analyzed in a univariate model. The presence of chronic rejection resulted in decreased (P=0.0001) 5-year graft survival for both cadaver graft (83.7% vs. 58.2%) and live donor graft (93.2% vs. 53.1%) recipients. Significant variables for the development of chronic rejection included an acute rejection episode (P=0.0001), a black recipient (P=0.0006), donor age > or = 50 years (P=0.006), and a serum creatinine level >2.0 mg/dl by 6 months after transplantation. Severity of rejection measured by peak serum creatinine or posttreatment return to baseline was not related to chronic rejection. However, acute rejection episodes lasting for more that 5 days (P=0.03) or occurring after 6 months (P=0.001) did influence time to chronic rejection. In addition, mismatching for donor-recipient race was a significant (P=0.008) risk factor for recipients of cadaver grafts. We conclude that acute rejection is the most significant risk factor for chronic rejection, and the long-term fate of grafts may be determined as early as the first 6 months. Racial matching of donor-recipient pairs may be useful to minimize chronic rejection risk. Future advances that diminish the incidence and severity of acute rejection may have the greatest impact on long-term survival.
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影响因子：
6.2
作者：
ALMOND, PS;MATAS, A;SCHAFFER
通讯作者：
SCHAFFER
膳食蛋白质对慢性肾移植排斥反应患者的影响。
影响因子：
19.6
作者：
Salahudeen,AK;Hostetter,TH;Raatz,SK;Rosenberg,ME
通讯作者：
Rosenberg,ME
克隆删除对肾移植物存活的有益输血作用。
影响因子：
6.2
作者：
Terasaki,PI
通讯作者：
Terasaki,PI
器官同种异体移植物的慢性排斥可能是由于急性排斥复发病灶持续受伤而自行消退所致。
影响因子：
0.9
作者：
Lowry,RP;Takeuchi,T;Cremisi,H;Konieczny,B;Someren,A
通讯作者：
Someren,A