The association of acute rejection vs recurrent glomerular disease with graft outcomes after kidney transplantation.
The association of acute rejection vs recurrent glomerular disease with graft outcomes after kidney transplantation.
复制标题
急性排斥反应与复发性肾小球疾病与肾移植后移植结果的关系。
DOI：
10.1111/ctr.13738
复制
发表时间：
2019
影响因子：
2.1
通讯作者：
Panzer,SarahE
中科院分区：
文献类型：
--
作者：
Singh,Tripti;Astor,BradC;Zhong,Weixiong;Mandelbrot,DidierA;Maursetter,Laura;Panzer,SarahE
研究背景肾小球肾炎（GN）复发对移植物存活的影响比急性排斥反应更大。因此，我们评估了在当前免疫抑制时代，经活检证实诊断为急性排斥反应或复发性GN后的同种异体移植物存活率。共有306例（35%）伊加，298例（35%）FSGS，177例（21%）狼疮性肾炎和81例（9%）膜性肾病患者进行了随访，平均随访时间为6.3年。在活检诊断为急性排斥反应或复发性肾小球疾病后，同种异体移植物丢失相似（11.5 vs 14.2/100人年，P= 0.15）。在疾病复发后2.5年，同种异体移植物存活率出现差异，与疾病复发后伊加相比，FSGS、MN或LN患者的移植物失败率显著更高（16.7 vs 7.5/100人年，P= 0.05）。伊加患者的移植物存活率的优势并没有实现显着的急性排斥反应后（P= 0.10伊加与FSGS，MN，LN）。ConclusionsAllograft生存相似疾病复发或急性排斥反应后，肾移植患者终末期肾病由于GN。
BackgroundIt has been shown that glomerulonephritis (GN) recurrence affects graft survival more than acute rejection. Thus, we assessed allograft survival after biopsy‐confirmed diagnosis of acute rejection or recurrent GN in current era of immunosuppression.MethodsAllograft survival following a biopsy diagnosis of acute rejection or recurrent GN was determined in adult kidney transplant recipients from 1994 to 2013. A total of 306 patients (35%) with IgA, 298 (35%) with FSGS, 177 (21%) with lupus nephritis, and 81 (9%) with membranous nephropathy were followed for a median of 6.3 years.ResultsAmong the 862 transplant recipients with primary GN, allograft loss was similar following a biopsy diagnosis of acute rejection or recurrent glomerular disease (11.5 vs 14.2/100 person‐years,P= .15). Differences in allograft survival emerged after 2.5 years following recurrent disease, with significantly higher graft failure in patients with FSGS, MN, or LN compared with IgA after recurrence of disease (16.7 vs 7.5/100 person‐years,P= .05). The advantage in allograft survival for IgA patients did not achieve significance after acute rejection (P= .10 for IgA vs FSGS, MN, and LN).ConclusionsAllograft survival was similar after disease recurrence or acute rejection after kidney transplant in patients with ESRD due to GN.