Laskow D A, Diethelm A G, Hudson S L, Deierhoi M H, Barber W H, Barger B O, Gaston R S, Julian B A, Curtis J J
University of Alabama School of Medicine, Department of Surgery, Birmingham.
Clin Transpl. 1991:179-91.
Over the 22 years comprising this review of living-related renal allografts, 3 distinct eras of immunosuppression protocols were used; Era I-aziathioprine and prednisone, Era II-cyclosporine, azathioprine, and prednisone; and Era III-Minnesota antilymphocyte globulin, cyclosporine, azathioprine, and prednisone. We analyzed both recipient and donor populations for graft and patient survival related to race, haplotype matching, diabetes, and immunosuppressive agents. Graft and patient survival have remained unchanged in 2-haplotype-matched recipients throughout the differing immunosuppression eras. The addition of cyclosporine, however, improved graft survival in the 1-haplotype living-related recipient. During the cyclosporine era, 1-haplotype White living-related recipient graft survival was significantly greater than 1-haplotype Black living-related recipient survivals. The reason for this disparity in graft survival does not appear to be related to noncompliance. The parametric hazard function analysis of the constant phase did not identify cyclosporine as a risk factor for late graft loss, suggesting that long-term cyclosporine usage may decrease the risk of graft loss. However, diabetes was demonstrated to be a risk factor for late graft loss. In diabetics, late graft loss is most likely secondary to death (usually cardiovascular) with a functioning graft. The organ donor pool is being expanded through the utilization of both older donors and living-unrelated donors. Graft survival in the living-unrelated group has been comparable to that of 1- and 2-haplotype-matched recipients. Results with older donors reveal donor age as a risk factor for late graft loss. The issue of living-unrelated transplantation remains controversial. In over 20 years of follow-up on our living-related donor population, we were unable to demonstrate any adverse long-term effects on renal function. Results of our analysis indicate that living-related renal donation continues to be a safe and valuable avenue for kidney transplantation.
在本次对亲属活体肾移植的22年回顾中，使用了3个不同阶段的免疫抑制方案；第一阶段——硫唑嘌呤和泼尼松，第二阶段——环孢素、硫唑嘌呤和泼尼松，以及第三阶段——明尼苏达抗淋巴细胞球蛋白、环孢素、硫唑嘌呤和泼尼松。我们分析了受者和供者群体中与种族、单倍型匹配、糖尿病及免疫抑制剂相关的移植物和患者存活率。在不同的免疫抑制阶段，2个单倍型匹配的受者的移植物和患者存活率保持不变。然而，对于1个单倍型匹配的亲属活体受者，添加环孢素可提高移植物存活率。在环孢素时代，1个单倍型匹配的白人亲属活体受者的移植物存活率显著高于1个单倍型匹配的黑人亲属活体受者。移植物存活率存在这种差异的原因似乎与不依从性无关。对稳定期的参数风险函数分析未将环孢素确定为晚期移植物丢失的风险因素，这表明长期使用环孢素可能会降低移植物丢失的风险。然而，糖尿病被证明是晚期移植物丢失的一个风险因素。在糖尿病患者中，晚期移植物丢失最可能继发于移植物功能正常时的死亡（通常为心血管相关）。通过使用年龄较大的供者和非亲属活体供者，器官供者库正在扩大。非亲属活体组的移植物存活率与1个和2个单倍型匹配的受者相当。对年龄较大供者的研究结果显示，供者年龄是晚期移植物丢失的一个风险因素。非亲属活体移植问题仍存在争议。在对我们的亲属活体供者群体进行的20多年随访中，我们未能证明对肾功能有任何不良长期影响。我们的分析结果表明，亲属活体肾捐赠仍然是肾脏移植的一条安全且有价值的途径。
