Recurrent and de novo renal diseases after renal transplantation: A report from the renal allograft disease registry
Recurrent and de novo renal diseases after renal transplantation: A report from the renal allograft disease registry
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DOI：
10.1053/ajkd.1998.v31.pm9631835
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发表时间：
1998-06-01
影响因子：
13.2
通讯作者：
Adams, MB
中科院分区：
文献类型：
--
作者：
Hariharan, S;Peddi, VR;Adams, MB
复发或新生肾小球疾病是移植物功能障碍和最终丧失的重要原因。环孢素A （CyA）改善了肾移植的短期预后，但没有改变移植的长期生存。本研究的目的是确定CyA时代这种疾病的患病率及其对移植物功能的影响。从1984年到1994年，在威斯康星医学院和辛辛那提大学进行了1557例同种异体肾脏移植手术。患者平均随访7.2年（最短1年）。98例（6.3%）患者在平均36个月后通过肾活检诊断出复发性疾病。有无复发患者的人口学特征相似。肾小球肾炎是最常见的发现，发生在73例患者中，包括局灶节段性肾小球硬化（FSGS）， 25；IgA肾病（IgAN）， 11；膜质（MN）， 11；增殖,11;膜增生性肾小球肾炎（MPGN）， 10；肾小球基底膜（抗gbm）， 3；系统性红斑狼疮（SLE） 2例，糖尿病肾病22例，溶血性尿毒症（HUS） 2例，草酸中毒1例。98例受者中有60例（61%）发生移植物丢失。复发性疾病患者的同种异体移植物半衰期缩短，分别为2038 +/- 225天和3135 +/- 385天，P = 0.002。移植后1年、3年、5年和8年的精算生存率分别为88%、74%、57%和34%；无复发患者相应的移植物存活率分别为80%、70%、64%和53% （P = 0.003）。随着移植物存活时间的延长，疾病复发的风险分别从2年的2.8%增加到5年和8年的9.3%和18.5%。我们得出结论，复发性疾病是肾移植后的一个重要问题，并与移植存活率降低有关。(C) 1998年由国家肾脏基金会，Inc。
Recurrent or de novo glomerular disease is an important cause of graft dysfunction and eventual loss. Cyclosporine A (CyA) has improved short-term renal allograft outcome but has not altered long-term graft survival. The purpose of the current study is to determine the prevalence of such disease and its impact on graft function in the CyA era. From 1984 to 1994, 1,557 renal allografts were performed at the Medical College of Wisconsin and the University of Cincinnati. Patients were followed up for an average of 7.2 years (minimum, 1 year). Recurrent disease was diagnosed by renal biopsy in 98 (6.3%) patients after an average of 36 months. Demographic characteristics of patients with and without recurrent disease were similar. Glomerulonephritis was the most common finding, occurring in 73 patients, and included focal segmental glomerulosclerosis (FSGS), 25; IgA nephropathy (IgAN), 11; membranous (MN), 11; proliferative, 11; membranoproliferative glomerulonephritis (MPGN), 10; glomerular basement membrane (anti-GBM), 3; and systemic lupus erythematosus (SLE), two, Diabetic nephropathy was present in 22, hemolytic uremic syndrome (HUS) in two, and oxalosis in one. Graft loss occurred in 60 of 98 (61%) recipients. Half-life of the allograft was diminished in patients with recurrent disease, 2,038 +/- 225 versus 3,135 +/- 385 days, P = 0.002. The actuarial allograft survival at 1, 3, 5, and 8 years posttransplantation with recurrence was 88%, 74%, 57%, and 34%, respectively; and the corresponding graft survival for patients without recurrent disease was 80%, 70%, 64%, and 53%, respectively (P = 0.003). The risk of recurrent disease increased with length of graft survival from 2.8% at 2 years to 9.3% and 18.5% at 5 and 8 years, respectively. We conclude that recurrent disease is a significant problem after renal transplantation and is associated with decreased graft, survival. (C) 1998 by the National Kidney Foundation, Inc.