Kidney allograft failure in the steroid-free immunosuppression era: A matched case-control study
Kidney allograft failure in the steroid-free immunosuppression era: A matched case-control study
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DOI：
10.1111/ctr.13117
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发表时间：
2017-11-01
影响因子：
2.1
通讯作者：
Muthukumar, Thangamani
中科院分区：
文献类型：
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作者：
Alkadi, Mohamad M.;Kim, Jim;Muthukumar, Thangamani
我们在本中心1670例肾移植受者中研究了死亡审查的同种异体肾移植失败的原因和预测因素。截至2012年1月1日，我们确定了137例同种异体移植失败的受者；其中130例(病例)在受者年龄、移植历年和供者类型方面与130例移植物功能正常的受者(对照组)进行了1：1匹配。移植失败的中位时间为29个月(四分位数范围：18-51)。经医生确认和活检证实的同种异体移植失败类型如下：急性排斥(21%)、肾小球疾病(19%)、移植肾小球病变(13%)、间质纤维化肾小管萎缩(10%)和多瘤病毒相关性肾病(7%)。21%的移植失败是由于医疗条件，9%的移植失败仍未解决。供者种族、供者年龄、人类白细胞抗原不匹配、血肌酐、尿蛋白、急性细胞排斥反应、抗体介导的急性排斥反应、BK病毒血症和CMV病毒血症与同种异体移植失败相关。移植失败的独立预测因素是移植后一年内的急性细胞排斥反应(优势比：18.31，95%可信区间：5.28-63.45)和尿蛋白=1g/d(5.85，2.37-14.45)。血清肌酐
We studied the causes and predictors of death-censored kidney allograft failure among 1670 kidney recipients transplanted at our center in the corticosteroid-free maintenance immunosuppression era. As of January 1, 2012, we identified 137 recipients with allograft failure; 130 of them (cases) were matched 1-1 for recipient age, calendar year of transplant, and donor type with 130 recipients with functioning grafts (controls). Median time to allograft failure was 29 months (interquartile range: 18-51). Physician-validated and biopsy-confirmed categories of allograft failure were as follows: acute rejection (21%), glomerular disease (19%), transplant glomerulopathy (13%), interstitial fibrosis tubular atrophy (10%), and polyomavirus-associated nephropathy (7%). Graft failures were attributed to medical conditions in 21% and remained unresolved in 9%. Donor race, donor age, human leukocyte antigen mismatches, serum creatinine, urinary protein, acute cellular rejection, acute antibody-mediated rejection, BK viremia, and CMV viremia were associated with allograft failure. Independent predictors of allograft failure were acute cellular rejection (odds ratio: 18.31, 95% confidence interval: 5.28-63.45) and urine protein >= 1g/d within the first year post-transplantation (5.85, 2.37-14.45). Serum creatinine