Rainiene Tatjana, Asakiene Egle, Zelvys Arūnas, Dainys Balys
Vilnius University Hospital Santariskiu klinikos, Santariskiu 2, 08406 Vilnius, Lithuania.
Medicina (Kaunas). 2005;41 Suppl 1:101-6.
The purpose of this study was to evaluate the incidence of delayed graft function and its impact on the antigraft response after cadaver kidney transplantation. The analysis is based on 183 consecutive cadaver kidney transplantations performed in Vilnius University Hospital Santariskiu klinikos from January 2000 to December 2004. Delayed graft function occurred in 21.3% (39/183) of kidney transplantations. The frequency and severity of acute rejection episodes in recipients during first three months after transplantation and graft survival rate at one and two years were evaluated. Group 1 consisted of 39 patients with delayed graft function and group 2 (control group) of 144 patients with graft function immediately after transplantation. The maintenance immunosuppressive therapy consisted of cyclosporine, mycophenolate mofetil/azathioprine and prednisolone. The proportion of patients treated with monoclonal antibodies was similar in both groups (35.9% vs. 33.3%). Actuarial graft survival was estimated by the modified Kaplan-Meier method, graft loss was censored for death of recipient with functioning transplant and other causes of loss not related to rejection. There were no significant differences in the age of recipients (42.3+/-11.3 vs. 39.4+/-14.1), as well as in HLA matching (2.2/6 M vs. 2.2/6 M), in the number retransplanted patients (10.3% vs. 10.4%) and in highly sensitized patients (plasma renin activity >50.0%) (5.1% vs. 4.8%) between those groups. Significant differences were observed in donors over 50 year (33.3% vs. 18.7%; p<0.05), in cold ischemic time over 20 h (53.8 vs. 32.6%, respectively). The occurrence of acute rejection episodes was higher in group 1 than in group 2 (69.2% (27/39) vs. 34.7% (50/144); chi2=14.9945, p<0.05). Graft survival was 88.5%, 84.3% at one year and two years in group 1 and 94.7%, 93.8% at one year and two years in group 2 (ns). Donor age >50, cerebral vascular disease as cause of donor death, and cold ischemic time >20 h are the main risk factors for delayed graft function. Delayed graft function is a risk factor for acute rejection episodes, but it has no impact on graft loss due to immunological reason at one and two years. These data may serve for tailoring immunosuppressive protocols.
本研究的目的是评估尸体肾移植后移植肾功能延迟的发生率及其对移植肾抗排斥反应的影响。分析基于2000年1月至2004年12月在维尔纽斯大学医院桑塔里斯基乌临床医院连续进行的183例尸体肾移植。183例肾移植中有21.3%（39/183）发生移植肾功能延迟。评估了移植后前三个月受者急性排斥反应的频率和严重程度以及一年和两年时的移植肾存活率。第1组由39例移植肾功能延迟的患者组成，第2组（对照组）由144例移植后立即具有肾功能的患者组成。维持性免疫抑制治疗包括环孢素、霉酚酸酯/硫唑嘌呤和泼尼松龙。两组中接受单克隆抗体治疗的患者比例相似（35.9%对33.3%）。采用改良的Kaplan-Meier方法估计移植肾的精算存活率，对于移植肾功能正常的受者死亡及其他与排斥无关的丢失原因导致的移植肾丢失进行截尾处理。两组受者年龄（42.3±11.3对39.4±14.1）、HLA配型（2.2/6 M对2.2/6 M）、再次移植患者数量（10.3%对10.4%）以及高敏患者（血浆肾素活性>50.0%）（5.1%对4.8%）方面均无显著差异。在年龄超过50岁的供者（33.3%对18.7%；p<0.05）、冷缺血时间超过20小时（分别为53.8%对32.6%）方面观察到显著差异。第1组急性排斥反应的发生率高于第2组（69.2%（27/39）对34.7%（50/144）；χ2=14.9945，p<0.05）。第1组一年和两年时的移植肾存活率分别为88.5%、84.3%，第2组一年和两年时分别为94.7%、93.8%（无显著性差异）。供者年龄>50岁、脑血管疾病作为供者死亡原因以及冷缺血时间>20小时是移植肾功能延迟的主要危险因素。移植肾功能延迟是急性排斥反应的一个危险因素，但对一年和两年时因免疫原因导致的移植肾丢失无影响。这些数据可用于调整免疫抑制方案。
