The hyperfiltration hypothesis in human renal transplantation.
The hyperfiltration hypothesis in human renal transplantation.
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DOI：
10.1097/00007890-199405000-00008
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发表时间：
1994-05
期刊：
影响因子：
6.2
通讯作者：
P. Terasaki;Hiroto Koyama;J. Cecka;D. Gjertson
中科院分区：
文献类型：
--
作者：
P. Terasaki;Hiroto Koyama;J. Cecka;D. Gjertson
超滤假说假设，肾脏质量减少的肾脏将由于剩余肾单位肥大以满足过度负荷而走向衰竭，最终导致肾单位衰竭。在人类肾移植中研究了可能怀疑超滤的五种情况：（1）来自4至6岁供体的小肾;（2）移植到大受体（超过100 kg）中;（3）从女性到男性的移植物与男性到女性的移植物相比;（4）发生排斥反应的肾脏;（5）尸体移植物与活体无关供体移植物相比。在所有5例患者中，透析需求和出院血清肌酐水平均较高，相应地，1年和3年移植物存活率低于对照组。出院SCr是1-3年移植物存活的最佳指标，并可用于测量肾脏与受体的“匹配”--即使在不需要透析的患者中，移植物存活也与出院SCr水平有关。这一假设的一个结果是，目前许多归因于排斥反应的晚期移植物丢失实际上可能是超滤失败。有证据表明，即使在出院时无排斥反应的患者中，如果其出院SCr值较高，报告的晚期排斥反应发生率也会逐渐升高。我们得出结论，5种可能怀疑超滤损伤的情况下，失败率增加。这种失败几乎从未被报告为“由于超滤”，并且可能被记录为拒绝。
The hyperfiltration hypothesis postulates that kidneys with reduced renal mass will progress toward failure due to hypertrophy of the remaining nephron to meet the excess load, eventually leading to nephron exhaustion. Five conditions in which hyperfiltration might be suspected were studied in human kidney transplantation: (1) small kidneys from donors aged 4 to 6; (2) transplants into large recipients (over 100 kg); (3) grafts from females to males compared with males to females; (4) kidneys that experience rejection episodes; and (5) cadaveric grafts compared with living-unrelated donor grafts. In all 5 instances, the requirement for dialysis and discharge serum creatinine level were both high--and, correspondingly, the 1- and 3-year graft survival rates were lower than the controls. The discharge SCr was the best indicator of 1-3-year graft survival and may serve to measure the "fit" of the kidney to the recipient--for even in patients requiring no dialysis graft survival was related to the discharge SCr levels. One consequence of this hypothesis is that many late graft losses currently attributed to rejections may, in fact, be hyperfiltration failures. As evidence, a progressively higher incidence of reported late rejections was noted even in patients who had been rejection-free at the time of discharge if they had higher discharge SCr values. We conclude that the 5 conditions under which hyperfiltration damage might be suspected had increased failure rates. Such failures are almost never reported as "due to hyperfiltration" and are probably recorded as rejections.