Ponticelli Claudio, Villa Margarita, Cesana Bruno, Montagnino Giuseppe, Tarantino Antonio
Divisione di Nefrologia e Dialisi, and Epidemiologic Unit, IRCCS Ospedale Maggiore Milano, Milano, Italy.
Kidney Int. 2002 Nov;62(5):1848-54. doi: 10.1046/j.1523-1755.2002.00612.x.
While graft survival rates in the short term have improved dramatically, only a modest improvement has been shown in long-term graft survival rates. We evaluated the causes of late failure in renal allograft recipients treated with cyclosporine A (CsA).
A total of 864 adults with a functioning graft at one year were evaluated. The end points were dialysis or death with a functioning graft.
The 13-year patient and graft survival probabilities were 0.82 and 0.64, respectively. The graft half-life was 20.1 years and the pure graft half-life was 31.1 years. At multivariate analysis, plasma creatinine at one year (P = 0.0006; RR 1.72), low-density lipoproteins (LDL) at one year (P = 0.0014; RR 1.65), older age (P = 0.0128; RR 1.50) and delayed graft function (P = 0.0350; RR 1.45) were associated with the end point. Chronic allograft nephropathy was the cause of failure in 97 patients, death in 70, recurrence of glomerulonephritis in 24, other events in 6. Cardiovascular complications were the most frequent cause of death. Post-transplant cardiovascular events were associated with: pre-transplant cardiovascular events (P = 0.0012; RR 2.65), older age (P = 0.0001; RR 2.46), pre-transplant arterial hypertension (P = 0.0249; RR 1.57), smoking (P = 0.0235; RR 1.29), duration of dialysis (P = 0.0229; RR 1.28). Mean serum cholesterol, LDL and triglycerides were each significantly associated post-transplant cardiovascular events.
The graft half-life was 20 years. Chronic allograft nephropathy was the leading cause of late failure, followed by death. If the data were censored by death, the projected pure graft half-life would be 31.1 years. Pre-transplant selection and preparation of the candidate as well as appropriate life style are recommended to improve life expectancy and extend graft survival.
虽然短期移植存活率已显著提高，但长期移植存活率仅略有改善。我们评估了接受环孢素A（CsA）治疗的肾移植受者晚期移植失败的原因。
对总共864例移植后一年移植肾功能正常的成年人进行了评估。终点指标为透析或移植肾功能正常时死亡。
13年的患者和移植肾存活概率分别为0.82和0.64。移植肾半衰期为20.1年，单纯移植肾半衰期为31.1年。多因素分析显示，移植后一年的血浆肌酐水平（P = 0.0006；相对风险1.72）、移植后一年的低密度脂蛋白（LDL）水平（P = 0.0014；相对风险1.65）、年龄较大（P = 0.0128；相对风险1.50）以及移植肾功能延迟恢复（P = 0.0350；相对风险1.45）与终点指标相关。慢性移植肾肾病是97例患者移植失败的原因，70例患者死亡原因是它，24例患者是肾小球肾炎复发，6例患者是其他事件。心血管并发症是最常见的死亡原因。移植后心血管事件与以下因素相关：移植前心血管事件（P = 0.0012；相对风险2.65）、年龄较大（P = 0.0001；相对风险2.46）、移植前动脉高血压（P = 0.0249；相对风险1.57）、吸烟（P = 0.0235；相对风险1.29）、透析时间（P = 0.0229；相对风险1.28）。移植后心血管事件与平均血清胆固醇、LDL和甘油三酯水平均显著相关。
移植肾半衰期为20年。慢性移植肾肾病是晚期移植失败的主要原因，其次是死亡。如果以死亡作为删失数据，则预计单纯移植肾半衰期为31.1年。建议在移植前对候选者进行选择和准备，并采取适当的生活方式，以提高预期寿命并延长移植肾存活时间。
