Arnol Miha, Prather Jonathan C, Mittalhenkle Anuja, Barry John M, Norman Douglas J
Transplant Medicine, Renal Transplant Program, Oregon Health and Science University, Portland, OR 97239, USA.
Transplantation. 2008 Oct 27;86(8):1084-9. doi: 10.1097/TP.0b013e318187ba5c.
Although survival of kidney regrafts is similar to that of primary grafts, risk factors associated with regraft survival have not been defined clearly. The aim of this study was to investigate risk factors for regraft outcome, including characteristics of the previous and current transplant, and time to retransplant.
In a historical cohort study, 966 primary and 176 repeat deceased donor kidney graft recipients transplanted between January 1, 1990 and December 31, 2004 were studied. Cox regression analysis was used to estimate graft loss hazard ratios (HR) for regrafts versus primary grafts. Adjustments were made for recipient and donor demographics, transplant-related factors (transplant era, panel reactive antibodies, human leukocyte antigens mismatches, immunosuppression, delayed graft function, acute rejection [AR]), previous transplant characteristics (graft survival, graft loss because of AR), and time to retransplant.
A total of 508 kidney grafts were lost in the period between January 1990 and May 2007: 427 primary grafts and 81 regrafts. Regraft recipients had a covariate-adjusted 6% increase in graft loss (HR=1.06; P=0.69). Regraft loss was significantly associated with previous graft survival less than or equal to 1 year (HR=2.01; P=0.004), previous graft loss because of AR (HR=2.26; P=0.017) and time to retransplant more than 1 year (HR=2.42; P=0.002). Other significant predictors of regraft loss were diabetes (HR=1.81), donor age more than 50 years (HR=1.86) and delayed graft function after retransplant (HR=1.95).
Kidney regrafts seem to have similar long-term outcome as primary grafts. However, additional risk factors significantly associated with regraft survival are previous graft survival, graft loss because of rejection, and time to retransplant.
尽管肾再次移植的存活率与初次移植相似，但与再次移植存活相关的危险因素尚未明确界定。本研究的目的是调查再次移植结局的危险因素，包括既往和当前移植的特征以及再次移植的时间。
在一项历史性队列研究中，对1990年1月1日至2004年12月31日期间移植的966例初次死亡供肾移植受者和176例再次死亡供肾移植受者进行了研究。采用Cox回归分析估计再次移植与初次移植的移植肾丢失风险比（HR）。对受者和供者的人口统计学特征、移植相关因素（移植时代、群体反应性抗体、人类白细胞抗原错配、免疫抑制、移植肾功能延迟、急性排斥反应[AR]）、既往移植特征（移植肾存活、因AR导致的移植肾丢失）以及再次移植时间进行了调整。
在1990年1月至2007年5月期间，共有508例移植肾丢失：427例初次移植肾和81例再次移植肾。再次移植受者经协变量调整后的移植肾丢失增加了6%（HR=1.06；P=0.69）。再次移植肾丢失与既往移植肾存活时间小于或等于1年（HR=2.01；P=0.004）、既往因AR导致的移植肾丢失（HR=2.26；P=0.017）以及再次移植时间超过1年（HR=2.42；P=0.002）显著相关。再次移植肾丢失的其他显著预测因素包括糖尿病（HR=1.81）、供者年龄超过50岁（HR=1.86）以及再次移植后移植肾功能延迟（HR=1.95）。
肾再次移植似乎与初次移植具有相似的长期结局。然而，与再次移植存活显著相关的其他危险因素是既往移植肾存活情况、因排斥反应导致的移植肾丢失以及再次移植时间。
