RISK-FACTORS FOR 2ND RENAL-ALLOGRAFTS IMMUNOSUPPRESSED WITH CYCLOSPORINE
RISK-FACTORS FOR 2ND RENAL-ALLOGRAFTS IMMUNOSUPPRESSED WITH CYCLOSPORINE
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DOI：
10.1097/00007890-199108000-00013
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发表时间：
1991-08-01
期刊：
影响因子：
6.2
通讯作者：
NAJARIAN, JS
中科院分区：
文献类型：
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作者：
ALMOND, PS;MATAS, AJ;NAJARIAN, JS
第二次移植肾存活率低于初次移植肾。对于接受硫唑嘌呤、泼尼松和明尼苏达ALG免疫抑制的受试者（常规免疫抑制），与第二次移植物存活率降低相关的风险因素已经确定：年龄> 40岁，尸体供体，初次移植物丢失和再次移植之间< 6个月，初次移植物功能持续时间（6个月或1年，取决于研究）、高峰群体反应性抗体、人类白细胞抗原错配数量和移植物功能延迟。在这项研究中，我们使用多变量分析来确定与接受或未接受环孢素治疗的患者的第二次移植存活率降低相关的风险因素。结果与原发性移植物存活率进行比较。接受常规免疫抑制治疗的患者的风险因素为：（a）6个月以上排斥反应导致的原发性移植物丢失（P = 0.01对比排斥< 6个月或非免疫学损失）;（B）尸体供体（P = 0.005 vs.生活相关）;（c）初次移植物丢失与再次移植之间的间隔大于或等于6个月（P = 0.05 vs. < 6个月）。对于CsA，降低第二次移植物存活率最多的风险因素是：（a）6个月以内排斥反应导致的原发性移植物丢失（P = 0.11 vs.非免疫学丢失）;（B）原发性移植物的常规免疫抑制（P = 0.08 vs. CsA免疫抑制）;（c）峰值PRA大于或等于21（P = 0.14 vs.峰值PRA 1-20）。对于CsA免疫抑制的第二次移植受体，移植后6个月以上的排斥反应或非免疫原因导致的原发性移植物丢失不是第二次移植物存活的危险因素。这些数据扩展了其他研究者最近的报告，确定了用CsA治疗的再移植受者的风险因素，并证明了再移植人群中的患者亚组可以在没有额外风险的情况下再移植（即，它们的第二次移植存活率与初次移植存活率相似）。如果将来器官分配是基于移植物存活数据，这一点可能会变得更加重要。如果是这样的话，我们的数据将支持CsA免疫抑制患者的再次移植，特别是那些因移植后6个月或6个月以上的排斥反应或非免疫原因而失去原代移植物的患者;接受活体相关移植物的患者;以及峰值PRA为1-20的患者。
Second renal allograft survival rates are lower than those of primary allografts. For recipients immunosuppressed with azathioprine, prednisone, and Minnesota ALG (conventional immunosuppression), risk factors associated with decreased second graft survival have been identified: age > 40, cadaver donor, < 6 months between primary graft loss and retransplantation, duration of primary graft function (6 months or 1 year, depending on the study), high peak panel-reactive antibody, number of human leukocyte antigen mismatches, and delayed graft function. In this study, we used a multivariate analysis to identify risk factors associated with decreased second graft survival in patients who did or did not receive cyclosporine. Results were compared with primary graft survival rates. Risk factors for patients receiving conventional immunosuppression were: (a) primary graft loss caused by rejection greater-than-or-equal-to 6 months (P = 0.01 vs. either rejection < 6 months or nonimmunologic loss); (b) cadaver donor (P = 0.005 vs. living related); and (c) interval between primary graft loss and retransplantation of greater-than-or-equal-to 6 months (P = 0.05 vs. < 6 months). For CsA, risk factors that most decreased second graft survival were: (a) primary graft loss caused by rejection < 6 months (P = 0.11 vs. nonimmunologic loss); (b) conventional immunosuppression for the primary graft (P = 0.08 vs. CsA immunosuppression); and (c) a peak PRA of greater-than-or-equal-to 21 (P = 0.14 vs. peak PRA of 1-20). For second graft recipients immunosuppressed with CsA, primary graft loss to either rejection > 6 months posttransplant or nonimmunologic causes was not a risk factor for second graft survival. These data extend the recent reports of other investigators by identifying risk factors for retransplant recipients treated with CsA and by demonstrating that subgroups of patients in the retransplant population can be retransplanted without additional risk (i.e., their second graft survival rates are similar to primary graft survival rates). This may become more important if, in the future, organ distribution is based on graft survival data. If so, our data would support retransplantation in patients who are immunosuppressed with CsA, especially those who lost their primary graft to either rejection greater-than-or-equal-to 6 months posttransplant or nonimmunologic causes; who receive living related grafts; and who have a peak PRA of 1-20.