Katz S M, Kerman R H, Golden D, Grevel J, Camel S, Lewis R M, Van Buren C T, Kahan B D
Department of Surgery, University of Texas Medical School, Houston 77030.
Transplantation. 1991 Feb;51(2):351-5.
The benefit of transplantation without prior dialysis might be contravened by the failure to develop possible immunologic disabilities associated with chronic uremia and dialysis. This study compares graft and patient outcome, cyclosporine toxicity, pharmacokinetics, rejection episodes, nutritional status, and social and vocational rehabilitation between a preemptive group of 85 patients transplanted without prior dialysis and a cohort of 84 demographically, temporally, and disease-matched recipients of renal transplants after a minimum of 6 months' chronic dialysis therapy. The groups were matched for donor type, gender, and age, as well as immunologic risk factors of HLA-mismatch and percent panel-reactive antibody. All patients received CsA and prednisone immunosuppression. There were only two differences between the cohorts. The preemptive group included more diabetic patients: 32 versus 15 (P less than 0.01). The control cohort included more recipients who had received any pretransplant transfusion: 55 versus 28 (P less than 0.001). Both of these factors (if having any impact) would be expected to reduce graft survival in the preemptive group. All patients in the study had a minimum follow-up of 1 year and over half of the recipients are beyond 40 months. The preemptive patients showed survival rates of 94, 93, and 91 percent at 1, 2, and 5 years. These rates were not significantly different from those of the control group, namely 96, 96, and 93 percent, respectively. The actuarial graft survival rates in the preemptive group of 83, 81, 76, 73, and 73 percent at 1, 2, 3, 4, and 5 years were not statistically different from the control group rates, namely 90, 81, 80, 77, and 76 percent. Preoperative blood transfusion or percent positive panel-reactive antibodies had no effect on postoperative outcome in either group. The incidence of CsA nephrotoxicity was 9.4 percent in the preemptive group, which was not statistically different from the 17.9 percent in the control group. The incidence of rejection episodes in the absence of patient noncompliance was comparable between the groups. Seven of the irreversible rejection episodes in the preemptive group were due to noncompliance, compared with none in the control group (P less than 0.001). Preemptive recipients were also more likely than control group patients to be employed fulltime both before transplantation (36 vs. 22, P less than 0.05) as well as after transplantation (38 vs. 20, P less than 0.01).(ABSTRACT TRUNCATED AT 400 WORDS)
未经预先透析的移植的益处可能会因未能发展与慢性尿毒症和透析相关的潜在免疫功能障碍而受到影响。本研究比较了85例未经预先透析的抢先移植患者组与84例经过至少6个月慢性透析治疗、在人口统计学、时间和疾病方面匹配的肾移植受者队列之间的移植物和患者结局、环孢素毒性、药代动力学、排斥反应、营养状况以及社会和职业康复情况。两组在供体类型、性别、年龄以及HLA错配和群体反应性抗体百分比等免疫风险因素方面进行了匹配。所有患者均接受环孢素和泼尼松免疫抑制治疗。两组之间仅有两个差异。抢先移植组的糖尿病患者更多：32例对15例（P<0.01）。对照组中接受过任何移植前输血的受者更多：55例对28例（P<0.001）。预计这两个因素（如果有任何影响）都会降低抢先移植组的移植物存活率。研究中的所有患者至少随访1年，超过一半的受者随访时间超过40个月。抢先移植患者在1年、2年和5年时的生存率分别为94%、93%和91%。这些比率与对照组的比率无显著差异，对照组分别为96%、96%和93%。抢先移植组在1年、2年、3年、4年和5年时的精算移植物存活率分别为83%、81%、76%、73%和73%，与对照组的比率（分别为90%、81%、80%、77%和76%）无统计学差异。术前输血或群体反应性抗体阳性百分比对两组的术后结局均无影响。抢先移植组中环孢素肾毒性的发生率为9.4%，与对照组的17.9%无统计学差异。在患者未出现不依从的情况下，两组之间排斥反应的发生率相当。抢先移植组中7例不可逆排斥反应是由于不依从导致的，而对照组中没有（P<0.001）。抢先移植受者在移植前全职工作的可能性也比对照组患者更大（36例对22例，P<0.05），移植后也是如此（38例对20例，P<0.01）。（摘要截断于400字）
