Sandrini S, Setti G, Bossini N, Zubani R, Cassamali S, Maiorca P, Maffeis R, Portolani N, Bonardelli S, Nodari F, Tardanico R, Corbetta G, Cancarini G
Department of Nephrology, University of Brescia and Spedali Civili, Brescia, Italy.
Transplant Proc. 2004 Mar;36(2 Suppl):152S-157S. doi: 10.1016/j.transproceed.2003.12.036.
Six hundred thirty-eight cadaveric kidney transplant patients between 1983 and 2001 were treated with cyclosporine (CsA) for 87 +/- 58 months. Among 571 patients with follow-up greater than 12 months, the 15-year renal function was investigated to assess the probability of a >30% increase in serum creatinine (sCr) above the month-6 value (baseline) and the impact on graft survival. At 15 years, patient and graft survival rates were 82.7% and 56.1%, respectively, with a 19.5-year half-life (censored for deaths). The main causes of graft loss were chronic rejection (33.0%) and patient death (24%). Cardiovascular disease and neoplasms were the main causes of death. Renal function remained stable in 266 patients (46.6%) with excellent sCr values observed even after a 15-year treatment period. An increased sCr was observed in 305 patients (53.4%) with a 15-year probability of 74%. In 178 patients (59.3%) it was self-limited; their grafts are still functioning well. One hundred three patients (32.8%) lost their graft which was more likely when the sCr had increased >45%. Twenty-four patients (7.9%) died with a functioning graft. Multivariate analysis showed the progression of graft deterioration to be related to proteinuria (P<.0001), a late acute rejection episode (P<.002), or the extent of sCr increase (P<.008). In conclusion, the long-term use of CsA has allowed us to achieve excellent long-term patient and transplant survival rates. Our data indicate a high 15-year probability of an increased sCr, but the rate of progression is slow.
1983年至2001年间，638例尸体肾移植患者接受了环孢素（CsA）治疗，治疗时间为87±58个月。在571例随访时间超过12个月的患者中，对其15年的肾功能进行了研究，以评估血清肌酐（sCr）较第6个月的值（基线）升高>30%的概率以及对移植物存活的影响。15年时，患者和移植物存活率分别为82.7%和56.1%，半衰期为19.5年（因死亡而截尾）。移植物丢失的主要原因是慢性排斥反应（33.0%）和患者死亡（24%）。心血管疾病和肿瘤是主要死亡原因。266例患者（46.6%）的肾功能保持稳定，即使在经过15年的治疗期后，sCr值仍非常理想。305例患者（53.4%）出现sCr升高，15年概率为74%。178例患者（59.3%）的sCr升高为自限性；他们的移植物仍功能良好。103例患者（32.8%）失去了移植物，当sCr升高>45%时更易发生。24例患者（7.9%）在移植物功能良好时死亡。多变量分析显示，移植物恶化的进展与蛋白尿（P<0.0001）、晚期急性排斥反应发作（P<0.002）或sCr升高程度（P<0.008）有关。总之，长期使用CsA使我们能够实现出色的长期患者和移植存活率。我们的数据表明，sCr升高的15年概率很高，但进展速度较慢。
