吸烟与慢性移植肾肾病

Cigarette smoking and chronic allograft nephropathy.

作者信息

Zitt Nina, Kollerits Barbara, Neyer Ulrich, Mark Walter, Heininger Dorothea, Mayer Gert, Kronenberg Florian, Lhotta Karl

机构信息

Clinical Division of Nephrology, Innsbruck Medical University, Anichstrasse 35, A-6020 Innsbruck, Austria,

出版信息

Nephrol Dial Transplant. 2007 Oct;22(10):3034-9. doi: 10.1093/ndt/gfm275. Epub 2007 May 21.

DOI:10.1093/ndt/gfm275

PMID:17517794

Abstract

BACKGROUND

Smoking has been demonstrated to decrease patient and graft survival after kidney transplantation. Data on histological changes associated with smoking in renal allografts are lacking.

METHODS

Smoking habits before and after renal transplantation were evaluated by questionnaire in 279 patients. A transplant biopsy was performed more than 1 year after transplantation in 76 of them. Histological changes were classified according to Banff 97 criteria. Linear regression analysis and proportional odds models for histological changes including the factors age, gender, diabetes, body mass index, donor age, time since transplantation, history of acute rejection and smoking status were calculated.

RESULTS

Overall 22% of patients continued smoking after transplantation, with the proportion decreasing from 38% of those transplanted before 1990 to 13% of those transplanted after 2000. Serum creatinine was non-significantly higher in smokers (2.3 +/- 2.7 mg/dl vs 1.8 +/- 1.4 mg/dl, P = 0.21). A renal biopsy was performed in 24% of non-smokers and 39% of smokers (P = 0.02), and smokers were biopsied on average 1.5 years earlier. Among biopsied patients current smokers tended to suffer more often from diabetes (25.0% vs 13.5%, P = 0.33), to develop transplant failure (33.3% vs 21.2%, P = 0.25) or experience a cardiovascular event (29.2% vs 15.4%, P = 0.16). The frequency of acute rejection was comparable between smokers and non-smokers (25.0% vs 34.6%, P = 0.40). Glomerular sclerosis was associated with diabetes (P = 0.03). Severity of vascular intimal fibrous thickening was associated with current smoking (P = 0.004), whereas the degree of arteriolar hyalinosis (P < 0.001) and chronic/sclerosing nephropathy (P = 0.05) were associated with time since transplantation.

CONCLUSIONS

The number of patients who continue cigarette smoking after renal transplantation has decreased in recent years. The main allograft lesion associated with smoking is fibrous intimal thickening of small arteries.

摘要

背景

吸烟已被证明会降低肾移植后患者及移植物的存活率。目前缺乏关于肾移植受者吸烟相关组织学变化的数据。

方法

通过问卷调查评估了279例患者肾移植前后的吸烟习惯。其中76例患者在移植1年多后进行了移植肾活检。组织学变化根据Banff 97标准进行分类。计算了包括年龄、性别、糖尿病、体重指数、供体年龄、移植后时间、急性排斥反应史和吸烟状况等因素在内的组织学变化的线性回归分析和比例优势模型。

结果

总体而言，22%的患者在移植后继续吸烟，这一比例从1990年前移植患者的38%降至2000年后移植患者的13%。吸烟者的血清肌酐略高，但无统计学意义（2.3±2.7mg/dl对1.8±1.4mg/dl，P=0.21）。24%的非吸烟者和39%的吸烟者进行了肾活检（P=0.02），吸烟者平均提前1.5年接受活检。在接受活检的患者中，目前吸烟者患糖尿病的比例往往更高（25.0%对13.5%，P=0.33），发生移植失败的比例更高（33.3%对21.2%，P=0.25）或发生心血管事件的比例更高（29.2%对15.4%，P=0.16）。吸烟者和非吸烟者的急性排斥反应发生率相当（25.0%对34.6%，P=0.40）。肾小球硬化与糖尿病有关（P=0.03）。血管内膜纤维增厚的严重程度与目前吸烟有关（P=0.004），而小动脉玻璃样变性程度（P<0.001）和慢性/硬化性肾病（P=0.05）与移植后时间有关。