Cransberg Karlien, Marlies Cornelissen E A, Davin Jean-Claude, Van Hoeck Koen J M, Lilien Marc R, Stijnen Theo, Nauta Jeroen
Department of Pediatric Nephrology of Erasmus MC Sophia, Rotterdam, the Netherlands.
Pediatr Transplant. 2005 Feb;9(1):104-11. doi: 10.1111/j.1399-3046.2005.00271.x.
Collaboration of the Dutch centers for kidney transplantation in children started in 1997 with a shared immunosuppressive protocol, aimed at improving graft survival by diminishing the incidence of acute rejections. This study compares the results of transplantations in these patients to those in a historical reference group. Ninety-six consecutive patients receiving a first kidney transplant were treated with an immunosuppressive regimen consisting of mycophenolate mofetil, cyclosporine and corticosteroids. The results were compared with those of historic controls (first transplants between 1985 and 1995, n = 207), treated with different combinations of corticosteroids, cyclosporine A and/or azathioprine. Cytomegalovirus (CMV) prophylaxis was prescribed to high-risk patients in the study group, and only a small proportion of the reference group. The graft survival at 1 yr improved significantly: 92% in the study group, vs. 73% in the reference group (p < 0.001). In the study group 63% of patients remained rejection-free during the first year; in the reference group 28% (p < 0.001). After statistical adjustment of differences in baseline data, as cold ischemia time, the proportion of LRD, preemptive transplantation, and young donors, the difference between study and reference group in graft survival (RR 0.33, p = 0.003) and incidence of acute rejection (RR 0.37, p < 0.001), as the only factor, remained statistically significant, indicating the effect of the immunosuppressive therapy. In the first year one case of malignancy occurred in each group. CMV disease occurred less frequently in the study group (11%) than in the reference group (26%, p = 0.02). As a new complication in 4 patients bronchiectasis was diagnosed. A new consensus protocol, including the introduction of mycophenolate mofetil, considerably improved the outcome of pediatric kidney transplantation in the Netherlands, measured as reduction of the incidence of acute rejection and improved graft survival.
荷兰儿童肾移植中心于1997年开始合作，采用共享的免疫抑制方案，旨在通过降低急性排斥反应的发生率来提高移植物存活率。本研究将这些患者的移植结果与一个历史参照组的结果进行比较。96例接受首次肾移植的连续患者接受了由霉酚酸酯、环孢素和皮质类固醇组成的免疫抑制方案治疗。将结果与历史对照组（1985年至1995年间的首次移植，n = 207）进行比较，历史对照组接受皮质类固醇、环孢素A和/或硫唑嘌呤的不同组合治疗。研究组对高危患者进行了巨细胞病毒（CMV）预防，而参照组只有一小部分患者接受了预防。1年时的移植物存活率显著提高：研究组为92%，而参照组为73%（p < 0.001）。研究组63%的患者在第一年无排斥反应；参照组为28%（p < 0.001）。在对基线数据差异（如冷缺血时间、活体亲属供肾比例、抢先移植和年轻供者比例）进行统计调整后，研究组和参照组在移植物存活率（RR 0.33，p = 0.003）和急性排斥反应发生率（RR 0.37，p < 0.001）方面的差异作为唯一因素仍具有统计学意义，表明免疫抑制治疗的效果。第一年每组各发生1例恶性肿瘤。研究组巨细胞病毒病的发生率（11%）低于参照组（26%，p = 0.02）。有4例患者被诊断出支气管扩张这一新增并发症。一项新的共识方案，包括引入霉酚酸酯，显著改善了荷兰儿童肾移植的结果，表现为急性排斥反应发生率降低和移植物存活率提高。
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