Acute rejection following renal transplantation. Evidence that severity is the best predictor of subsequent graft survival time.
Acute rejection following renal transplantation. Evidence that severity is the best predictor of subsequent graft survival time.
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肾移植后的急性排斥反应。
DOI：
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发表时间：
1998
影响因子：
2.1
通讯作者：
Ronald M. Ferguson
中科院分区：
文献类型：
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作者：
R. Pelletier;F. Cosio;Mitchell L. Henry;G. Bumgardner;E. A. Davies;E. Elkhammas;Ronald M. Ferguson
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及时识别影响肾移植后移植物存活时间的危险因素可以促进临床干预措施的发展，从而延长移植物存活的寿命。为了确定这些危险因素，我们对 1982 年 9 月 22 日至 1996 年 6 月 14 日期间在俄亥俄州立大学移植计划中进行的 1949 例肾移植的临床结果进行了回顾性分析。急性排斥（AR）发作的次数最能预测移植物存活时间的缩短。第一次 AR 发作严重程度（使用治疗后血清肌酐 (RxCr) 和基线血清肌酐 (BCr) 之间的差异进行索引，或 DeltaCr = RxCr - BCr）是经历 AR 的患者移植物存活时间的最佳预测因子 (r = 0.27，p < 0.0001)。随后的 AR 发作在 DeltaCr 较高的患者中更频繁地发生。然而，对于仅发生过一次 AR 的患者，DeltaCr 是移植物存活时间的最佳预测因子（r = 0.44，p < 0.0001）。第一次 AR 发作的严重程度 (DeltaCr) 与后续 AR 发作的风险、第二次 AR 发作的严重程度以及第一次 AR 发作之后（但不是之前）获得的平均血压平均值相关。因此，我们得出的结论是，第一次 AR 发作的严重程度是所有经历 AR 的患者中同种异体肾移植存活时间的最佳预测因子，与随后的 AR 发作无关，并与也影响同种肾移植存活时间的后续临床事件相关。因此，对第一次 AR 发作进行早期诊断和积极治疗是有必要的，以尽量减少 AR 的严重程度，从而最大限度地延长随后的移植物存活时间。
结论
肾移植后首次急性排斥反应的严重程度是移植物存活时间的最佳决定因素，并与随后的临床事件相关，这可能进一步缩短移植物的存活时间。
UNLABELLED
Timely recognition of risk factors influencing graft survival time following kidney transplantation could facilitate the development of clinical interventions that would increase the longevity of graft survival. To identify these risk factors, we performed a retrospective analysis of the clinical outcome of 1949 renal transplants performed at The Ohio State University Transplant Program between 22 September 1982 and 14 June 1996. The number of acute rejection (AR) episodes was most predictive of shorter graft survival time. The first AR episode severity (indexed using the difference between post-treatment serum creatinine (RxCr) and baseline serum creatinine (BCr), or DeltaCr = RxCr - BCr) was the best predictor of graft survival time (r = 0.27, p < 0.0001) in patients experiencing AR. Subsequent AR episodes occurred more frequently in patients with a higher DeltaCr. However, DeltaCr was the best predictor of graft survival time (r = 0.44, p < 0.0001) in patients who had only one AR episode. The severity of the first AR episode (DeltaCr) correlated with the risk of subsequent AR episodes, the severity of a second AR episode and the average of mean blood pressures obtained after, but not before, the first AR episode. Therefore, we conclude that the severity of the first AR episode was the best predictor of renal allograft survival time in all patients experiencing AR, independent of subsequent AR episodes and correlated with subsequent clinical events which also influence renal allograft survival time. Thus, early diagnosis and aggressive treatment of the first AR episode are warranted to minimize AR severity and thereby maximize subsequent graft survival time.
CONCLUSIONS
The severity of the first acute rejection episode following renal transplantation is the best determinant of graft survival time and correlates with subsequent clinical events which could further reduce graft survival time.