Based upon analyses of 40,671 kidney transplants reported to the UNOS Scientific Renal Transplant Registry between October 1987 and August 1992: 1. Twenty-four percent of the 21,923 recipients of first cadaver grafts experienced one or more rejection episodes during their transplant hospitalization, 52% during the first 6 months. At 12 months, only 40% of patients remained rejection-free. Patients who experienced any rejection during the first 6 months had a 72% 1-year graft survival rate compared with 95% for those who remained rejection-free (p < 0.001). 2. Recipients of transplants from living donors had a significantly lower incidence of rejection episodes. There was a clear effect of histocompatibility in comparing the incidence of rejection in HLA-identical sibling transplants (8% at discharge and 32% at 1 year) with that in 1-haplotype disparate transplants (22% at discharge and 52% at 1 year, p < 0.01 at each time point). Rejections were reported for 25% of transplants from other living donors at discharge and for 56% at 1 year, similar to the figures for cadaver transplants. 3. Histocompatibility also influenced the incidence of rejection in first cadaver-donor transplants. Only 15% of recipients of 0-HLA-A,B mismatched kidneys had rejection episodes reported at discharge, compared with 26% of those who received kidneys completely mismatched for HLA-A,B antigens (p < 0.01). At 1 year, 56% of HLA-A,B matched patients remained rejection-free, whereas only 35% of those mismatched for 4 antigens had no reported rejection through the first year (p < 0.01). Considering HLA-DR antigen mismatches, 19% of the 0-antigen mismatched group had rejection episodes at discharge, versus 28% for those with 2 HLA-DR mismatches (p < 0.01), and at 1 year, the percentage who were rejection-free decreased from 48% to 40% and 34% with 0, 1, and 2 HLA-DR mismatches, respectively. 4. The incidence of rejection episodes decreased as the recipient's age increased. Patients under age 16 had the highest incidence prior to discharge (28%) and at 1 year (70%) compared with 17% and 47% at the same intervals in patients over age 60 (p < 0.01). 5. The donor's age also had a significant effect on rejection episodes. Transplants from pediatric and older donors had a higher incidence of reported rejections than those from donors aged 16-30, especially after hospital discharge.(ABSTRACT TRUNCATED AT 400 WORDS)
基于对1987年10月至1992年8月间向美国器官共享联合网络（UNOS）科学肾脏移植登记处报告的40671例肾脏移植的分析：1. 在21923例首次接受尸体供肾移植的受者中，24%在移植住院期间经历了一次或多次排斥反应，52%在头6个月内经历了排斥反应。到12个月时，只有40%的患者仍未发生排斥反应。在头6个月内经历过任何排斥反应的患者，其移植肾1年存活率为72%，而未发生排斥反应的患者为95%（p<0.001）。2. 活体供肾移植受者的排斥反应发生率显著较低。在比较 HLA 相同的同胞移植（出院时为8%，1年时为32%）与1个单倍型不同的移植（出院时为22%，1年时为52%，各时间点p<0.01）的排斥反应发生率时，组织相容性有明显影响。来自其他活体供者的移植中，25%在出院时报告发生排斥反应，1年时为56%，与尸体移植的数字相似。3. 组织相容性也影响首次尸体供肾移植的排斥反应发生率。0个 HLA-A、B错配的肾脏受者中，只有15%在出院时报告有排斥反应，而接受 HLA-A、B抗原完全错配肾脏的受者中这一比例为26%（p<0.01）。1年时，HLA-A、B匹配的患者中有56%仍未发生排斥反应，而4个抗原错配的患者中只有35%在第1年未报告有排斥反应（p<0.01）。考虑 HLA-DR 抗原错配情况，0抗原错配组中19%在出院时发生排斥反应，而有2个 HLA-DR 错配的患者中这一比例为28%（p<0.01），1年时，未发生排斥反应的比例分别从0个、1个和2个 HLA-DR 错配时的48%降至40%和34%。4. 排斥反应发生率随受者年龄增加而降低。16岁以下的患者在出院前（28%）和1年时（70%）的排斥反应发生率最高，而60岁以上患者在相同时间间隔内的这一比例分别为17%和47%（p<0.01）。5. 供者年龄对排斥反应也有显著影响。来自小儿和老年供者的移植报告的排斥反应发生率高于来自16至30岁供者的移植，尤其是在出院后。（摘要截于400字）
