Matas A J, Gillingham K J, Humar A, Dunn D L, Sutherland D E, Najarian J S
Department of Surgery, University of Minnesota Medical School, Minneapolis 55455, USA.
Transplantation. 2000 Jan 15;69(1):54-8. doi: 10.1097/00007890-200001150-00011.
There is a debate about the relative contribution of immunologic (rejection) and nonimmunologic (limited nephron mass) factors in long-term graft survival.
Using multivariate analysis, we studied the association of the following variables with outcome: delayed graft function (DGF), acute rejection, recipient race (black vs. nonblack), donor age (<50 vs. > or =50), donor race, and donor and recipient gender. Because of the association between DGF and rejection, recipients were grouped as follows: DGF, rejection; DGF, no rejection; no DGF, rejection; no DGF, no rejection. Data were analyzed on 1199 first kidney transplants in adults (752 living donor, 447 cadaver donor) done between January 1, 1985 and December 31, 1996. Two analyses were done: first, all transplants; second, only those with > or =1 year survival. For both, there was no difference in risk factors if death with function was or was not censored.
For all cadaver transplant recipients, risk factors were acute rejection, DGF plus rejection, black recipient race, and donor age > or =50. For living donor recipients, only acute rejection was a risk factor. When only 1-year graft survivors were considered, risk factors were the same: for cadaver recipients, risk factors were acute rejection, DGF plus rejection, black recipient race, and donor age > or =50; for living donor recipients the risk factor was rejection.
We found immunologic factors (rejection with or without DGF) to be significant in both living donor and cadaver donor transplants. Nonim. munologic factors (donor age, recipient race) were significant only in cadaver donor transplants.
关于免疫因素（排斥反应）和非免疫因素（肾单位数量有限）对长期移植肾存活的相对贡献存在争议。
我们采用多变量分析，研究以下变量与移植结果的关联：移植肾功能延迟恢复（DGF）、急性排斥反应、受者种族（黑人与非黑人）、供者年龄（<50岁与≥50岁）、供者种族以及供者和受者性别。由于DGF与排斥反应之间存在关联，将受者分为以下几组：DGF且有排斥反应；DGF但无排斥反应；无DGF但有排斥反应；无DGF且无排斥反应。对1985年1月1日至1996年12月31日期间进行的1199例成人首次肾移植（752例活体供肾，447例尸体供肾）的数据进行分析。进行了两项分析：首先，对所有移植病例；其次，仅对存活≥1年的病例。对于这两项分析，无论是否对有功能时死亡进行截尾，危险因素均无差异。
对于所有尸体供肾移植受者，危险因素为急性排斥反应、DGF合并排斥反应、黑人受者种族以及供者年龄≥50岁。对于活体供肾移植受者，仅急性排斥反应是危险因素。当仅考虑移植肾存活1年的受者时，危险因素相同：对于尸体供肾受者，危险因素为急性排斥反应、DGF合并排斥反应、黑人受者种族以及供者年龄≥50岁；对于活体供肾移植受者，危险因素为排斥反应。
我们发现免疫因素（伴有或不伴有DGF的排斥反应）在活体供肾和尸体供肾移植中均具有重要意义。非免疫因素（供者年龄、受者种族）仅在尸体供肾移植中具有重要意义。
