Features of acute rejection that increase risk for chronic rejection.
Features of acute rejection that increase risk for chronic rejection.
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急性排斥反应的特征会增加慢性排斥反应的风险。
DOI：
10.1097/00007890-199910270-00023
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发表时间：
1999
期刊：
影响因子：
6.2
通讯作者：
Matas,AJ
中科院分区：
文献类型：
--
作者：
Humar,A;Kerr,S;Gillingham,KJ;Matas,AJ
背景：急性排斥反应 (AR) 已被证明是肾移植受者慢性排斥反应 (CR) 的重要危险因素，但许多 AR 受者并未进展为 CR。本研究的目的是确定某些 AR 发作是否与较差的预后相关。方法。研究组由 279 名肾移植受者组成，全部接受过单次经活检证实的 AR 发作的治疗。所有 AR 发作最初均采用类固醇治疗；结果。首先，通过单变量技术，我们确定了 AR 严重程度（通过 δ 肌酐 [dCr] 估计，定义为 AR 治疗后 6 周基线血清肌酐水平的变化）对两个不同终点（活检证实的 CR 和移植物存活）的临床影响。无论 6 周 dCr 情况如何，所有 AR 受者的 CR 风险均显着高于无 AR 受者（P < 0.01）。 dCr 在 0.5 至 1.0 mg/dl 之间的受者的 CR 发生率显着高于 dCr < 0.5 mg/dl 的受者 (P < 0.05)，但其发生率显着低于 dCr > 1.0 mg/dl 的受者 (P < 0.05)。然后我们进行了多变量分析。我们使用 AR 的严重程度以及其他变量（例如 AR 的时间、供体年龄）来确定哪些因素与 CR 和移植物丢失风险最相关。 CR 风险随移植后 6 个月以上发生 AR 事件而增加（相对风险 [RR]= 3.8，P= 0.005）；中度或重度（相对于轻度）AR 发作（RR= 2.7，P= 0.05）； AR 治疗后 6 周时 dCr > 0.5 mg/dl（vs.< 0.5 mg/dl）（RR= 2.3，P= 0.1）。当移植物存活（死亡审查）而不是 CR 为终点时，结果相似。结论。所有 AR 发作都与 CR 风险增加有关。但移植后 6 个月以上发生的 AR 发作以及严重程度增加的 AR 发作（通过组织学分级定性评估和 dCr 定量评估）带来最大的风险。具有这些危险因素的接受者可以采取措施降低 CR 风险，包括试验新型免疫抑制疗法。
Background.Acute rejection (AR) has been shown to be a significant risk factor for chronic rejection (CR) in kidney transplant recipients, yet many recipients with AR do not progress to CR. The purpose of this study was to determine if certain AR episodes are associated with a worse prognosis.Methods.The study group consisted of 279 kidney transplant recipients, all treated for a single episode of biopsy-proven AR. All AR episodes were initially treated with steroids; steroid-resistant rejection was managed with an antibody preparation.Results.First, by univariate techniques, we determined the clinical impact of severity of AR (as estimated by delta creatinine [dCr], defined as the change in baseline serum creatinine level 6 weeks after AR treatment) on two different endpoints-biopsy-proven CR and graft survival. Irrespective of 6-week dCr, all recipients with AR had a significantly increased risk of CR vs. those with no AR (P< 0.01). Recipients with dCr between 0.5 and 1.0 mg/dl had a significantly higher incidence of CR vs. those with dCr< 0.5 mg/dl (P< 0.05), but a significantly lower incidence vs. those with dCr> 1.0 mg/dl (P< 0.05). We then performed multivariate analysis. We used severity of AR in addition to other variables (eg, timing of AR, donor age) to determine which factors were most associated with risk for CR and graft loss. Risk for CR increased with AR episodes occurring> 6 months after transplant (relative risk [RR]= 3.8, P= 0.005); with moderate or severe (vs. mild) AR episodes (RR= 2.7, P= 0.05); and with dCr> 0.5 mg/dl (vs.< 0.5 mg/dl) at 6 weeks after AR treatment (RR= 2.3, P= 0.1). Findings were similar when graft survival (death-censored) was the end-point instead of CR.Conclusions.All AR episodes are associated with some increase in the risk for CR. But AR episodes occurring> 6 months after transplant and those of increased severity (as assessed qualitatively by histologic grading and quantitatively by dCr) confer the greatest risk. Recipients with these risk factors could be targeted with measures to decrease their risk for CR, including trials of novel immunosuppressive regimens.
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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。
影响因子：
6.2
作者：
S. Flechner;C. Modlin;D. Serrano;D. Goldfarb;D. Papajcik;B. Mastroianni;M. Goormastic;A. Novick
通讯作者：
A. Novick
肾移植和心脏移植受者急性与慢性移植排斥关系的批判性评估。
影响因子：
0.9
作者：
G. Opelz
通讯作者：
G. Opelz
影响因子：
6.2
作者：
ALMOND, PS;MATAS, A;SCHAFFER
通讯作者：
SCHAFFER
影响因子：
2.1
作者：
R. Pelletier;F. Cosio;Mitchell L. Henry;G. Bumgardner;E. A. Davies;E. Elkhammas;Ronald M. Ferguson
通讯作者：
Ronald M. Ferguson
排斥反应对肾移植物的长期存活没有有害影响，且功能完全恢复。
影响因子：
6.2
作者：
P. Vereerstraeten;D. Abramowicz;L. De Pauw;P. Kinnaert
通讯作者：
P. Kinnaert