Preemptive transplantation--an analysis of benefits and hazards in 85 cases.
Preemptive transplantation--an analysis of benefits and hazards in 85 cases.
复制标题
抢先移植——85例获益与危害分析
作者：
S. Katz;R. Kerman;D. Golden;J. Grevel;S. Camel;R. Lewis;C. V. van Buren;B. Kahan
没有预先透析的移植的好处可能会被与慢性尿毒症和透析相关的免疫功能障碍的失败所违背。本研究比较了移植物和患者的结果，环孢素的毒性，药代动力学，排斥反应，营养状况，以及社会和职业康复之间的抢先组85例移植前没有透析和一个队列的84个人口统计学，时间，和疾病匹配的肾移植受者后，至少6个月的慢性透析治疗。两组受试者的供者类型、性别、年龄以及HLA错配和群体反应性抗体百分比等免疫学风险因素相匹配。所有患者均接受CsA和泼尼松免疫抑制治疗。队列之间只有两个差异。先行组包括更多的糖尿病患者：32比15（P <0.01）。对照组包括更多接受过任何移植前输血的受者：55对28（P <0.001）。这两个因素（如果有任何影响）预计会降低抢先组的移植物存活率。研究中的所有患者都进行了至少1年的随访，超过一半的接受者超过40个月。先发制人的患者在1年、2年和5年的生存率分别为94%、93%和91%。这些比率与对照组（分别为96%、96%和93%）没有显著差异。在1年、2年、3年、4年和5年时，抢先组的精确移植物存活率分别为83%、81%、76%、73%和73%，与对照组的90%、81%、80%、77%和76%相比，没有统计学差异。术前输血或阳性群体反应性抗体百分比对两组的术后结果均无影响。CsA肾毒性的发生率为9.4%，与对照组的17.9%相比无统计学差异。在没有患者不依从的情况下，两组之间的排斥反应发生率相当。7例不可逆性排斥反应发生在抢先治疗组，与对照组相比，没有（P小于0.001）。在移植前（36 vs. 22，P <0.05）和移植后（38 vs. 20，P <0.01），优先受者也比对照组患者更有可能全职工作。（400字处截断摘要）
The benefit of transplantation without prior dialysis might be contravened by the failure to develop possible immunologic disabilities associated with chronic uremia and dialysis. This study compares graft and patient outcome, cyclosporine toxicity, pharmacokinetics, rejection episodes, nutritional status, and social and vocational rehabilitation between a preemptive group of 85 patients transplanted without prior dialysis and a cohort of 84 demographically, temporally, and disease-matched recipients of renal transplants after a minimum of 6 months' chronic dialysis therapy. The groups were matched for donor type, gender, and age, as well as immunologic risk factors of HLA-mismatch and percent panel-reactive antibody. All patients received CsA and prednisone immunosuppression. There were only two differences between the cohorts. The preemptive group included more diabetic patients: 32 versus 15 (P less than 0.01). The control cohort included more recipients who had received any pretransplant transfusion: 55 versus 28 (P less than 0.001). Both of these factors (if having any impact) would be expected to reduce graft survival in the preemptive group. All patients in the study had a minimum follow-up of 1 year and over half of the recipients are beyond 40 months. The preemptive patients showed survival rates of 94, 93, and 91 percent at 1, 2, and 5 years. These rates were not significantly different from those of the control group, namely 96, 96, and 93 percent, respectively. The actuarial graft survival rates in the preemptive group of 83, 81, 76, 73, and 73 percent at 1, 2, 3, 4, and 5 years were not statistically different from the control group rates, namely 90, 81, 80, 77, and 76 percent. Preoperative blood transfusion or percent positive panel-reactive antibodies had no effect on postoperative outcome in either group. The incidence of CsA nephrotoxicity was 9.4 percent in the preemptive group, which was not statistically different from the 17.9 percent in the control group. The incidence of rejection episodes in the absence of patient noncompliance was comparable between the groups. Seven of the irreversible rejection episodes in the preemptive group were due to noncompliance, compared with none in the control group (P less than 0.001). Preemptive recipients were also more likely than control group patients to be employed fulltime both before transplantation (36 vs. 22, P less than 0.05) as well as after transplantation (38 vs. 20, P less than 0.01).(ABSTRACT TRUNCATED AT 400 WORDS)