Kaplan Bruce, West-Thielke Patricia, Herren Heather, Gill John, Knoll Greg A, Oberholzer Jose, Sankary Howard, Benedetti Enrico
Department of Surgery, University of Illinois, Transplant Center, Chicago, IL 60612, USA.
Transplantation. 2008 Nov 15;86(9):1229-33. doi: 10.1097/TP.0b013e318188ad11.
We hypothesized that many reported and presumed isolated pancreas acute rejection episodes in simultaneous pancreas kidney patients may in fact be missed concordant kidney acute rejection episodes.
To test this hypothesis, we undertook an analysis of the Organ Procurement and Transplant Network database from 1995 to 2006 to assess the impact of reported isolated pancreas rejection on kidney allograft outcomes. The primary outcome of interest was kidney graft status beyond the first posttransplant year.
For overall graft survival, we found that when pancreas alone rejection was compared with no rejection there was a significant difference between the curves (log-rank P<0.0001). In addition, this endpoint was also significant for death censored graft survival (log-rank P=0.0036). For both overall and death censored graft survival the multivariate analyses demonstrated an increased risk (adjusted hazards ratio: 2.46, 3.22, respectively) for patients reported to have pancreas alone rejection.
These results indicate that patients with isolated pancreas rejection have worse renal allograft survival than patients reported as having no acute rejection and fare at least as poorly as those with reported kidney graft rejection supporting the concept of concordance of acute rejection in the majority of patients.
我们推测，在同时进行胰腺-肾脏移植的患者中，许多报告的和推测的孤立性胰腺急性排斥反应事件实际上可能是被漏诊的一致性肾脏急性排斥反应事件。
为验证这一假设，我们对1995年至2006年器官获取与移植网络数据库进行了分析，以评估报告的孤立性胰腺排斥反应对肾脏移植结果的影响。主要关注的结局是移植后第一年之后的肾脏移植状态。
对于总体移植存活率，我们发现，将单纯胰腺排斥反应与无排斥反应进行比较时，曲线之间存在显著差异（对数秩检验P<0.0001）。此外，对于死亡删失的移植存活率，这一终点也具有显著性（对数秩检验P=0.0036）。对于总体和死亡删失的移植存活率，多变量分析均显示，报告有单纯胰腺排斥反应的患者风险增加（调整后的风险比分别为2.46和3.22）。
这些结果表明，孤立性胰腺排斥反应患者的肾脏移植存活率低于报告无急性排斥反应的患者，且其情况至少与报告有肾脏移植排斥反应的患者一样差，这支持了大多数患者急性排斥反应具有一致性的概念。
