Giral Magali, Pascuariello Giovani, Karam Georges, Hourmant Maryvonne, Cantarovich Diego, Dantal Jacques, Blancho Gilles, Coupel Stephanie, Josien Regis, Daguin Pascal, Méchineau Sandra, Soulillou Jean Paul
Institut de Transplantation Et de Recherche en Transplantation, Inserm U437 (Immunointervention dans les Allo et Xénotransplantation), and Service d'urologie, Place Alexis Ricordeau, Nantes, France.
Kidney Int. 2002 May;61(5):1880-6. doi: 10.1046/j.1523-1755.2002.00323.x.
Long-term graft function is the result of multiple parameters, including both immune and non-immune components, which have a beneficial or detrimental potential. Among these, despite its frequency and theoretical interest (expression of "danger signals" in the graft itself), the effects of acute graft pyelonephritis (AGPN) on immediate and long-term outcome have not been studied in a large series. This article reviews a cohort of 1387 consecutive primary renal transplant recipients.
The objective of the study was to define the risk factor for AGPN, the risk profile for recurrence, and the impact of AGPN on long-term graft survival. According to a higher risk for AGPN in females during their follow-up, statistical analyses (Cox model, and multiple regression analysis) were performed by recipient sex strata.
Multivariate analysis showed that CMV infection was the only risk factor for AGPN occurrence. AGPN occurred in 13% of the graft recipients during their follow-up. Taken as a whole, AGPN was not associated with a significantly poor long-term outcome. However, when assessed in more detail, the outcome of this population was found to be more complex and to depend on several factors. Early AGPN (during the first 3 months) was significantly detrimental for graft outcome, independently of acute rejection episodes. Moreover, E. coli involvement in a first episode was linked to an increased AGPN recurrence.
This analysis did not support the concept that with current immunosuppression, strong "danger signals" such as those derived from bacteria within an allograft, are instrumental in initiating acute or chronic rejection.
长期移植肾功能是多种参数的结果，包括免疫和非免疫成分，这些成分具有有益或有害的可能性。其中，尽管急性移植肾盂肾炎（AGPN）发生率较高且具有理论研究价值（移植器官本身“危险信号”的表达），但尚未对大量病例进行过AGPN对近期和远期结局影响的研究。本文回顾了1387例连续的初次肾移植受者队列。
本研究的目的是确定AGPN的危险因素、复发风险特征以及AGPN对长期移植肾存活的影响。鉴于女性在随访期间发生AGPN的风险较高，故按受者性别分层进行统计分析（Cox模型和多元回归分析）。
多变量分析显示，巨细胞病毒（CMV）感染是AGPN发生的唯一危险因素。13%的移植受者在随访期间发生了AGPN。总体而言，AGPN与长期预后不良无显著相关性。然而，更详细评估时发现，该人群的结局更为复杂，且取决于多个因素。早期AGPN（前3个月内）对移植肾结局有显著不利影响，与急性排斥反应无关。此外，首次发作时大肠杆菌感染与AGPN复发增加有关。
该分析不支持以下观点：在当前免疫抑制情况下，诸如来自同种异体移植器官内细菌的强烈“危险信号”可引发急性或慢性排斥反应。
