Gruber Scott A, Brown Kristian L, El-Amm Jose M, Singh Atul, Mehta Kalyani, Morawski Katherina, Cincotta Elizabeth, Nehlsen-Cannarella Sandra, Losanoff Julian E, West Miguel S, Doshi Mona D
Section of Transplant Surgery, Department of Surgery, Wayne State University School of Medicine, Detroit, MI, USA.
Surgery. 2009 Oct;146(4):646-52; discussion 652-3. doi: 10.1016/j.surg.2009.05.020.
Graft survival following renal retransplantation has been inferior to that following primary allografting, particularly in African Americans (AAs) receiving deceased-donor (DD) kidneys.
Among 166 AA DD renal allograft recipients transplanted from July 2001 through July 2007, we compared the outcomes of 26 (16%) receiving a second graft with those of 140 primary cases. All patients received either thymoglobulin (ATG) or an IL-2 receptor antagonist for induction, and were maintained on either tacrolimus or sirolimus + mycophenolate mofetil +/- prednisone.
When compared with primary transplants, regrafts received kidneys from older donors, were younger, more sensitized, more likely to receive ATG and to be maintained on prednisone, received more doses of ATG, and were less likely diabetic. There was no difference between primary and retransplant groups in overall patient or graft survival; incidence of acute rejection, CMV infection, BK nephropathy, or new-onset diabetes mellitus; and serum creatinine at 1 year.
AA renal allograft recipients can undergo a second DD transplant with intermediate-term outcomes comparable to that of a primary graft, despite the presence of multiple immunologic and non-immunologic high-risk factors, by extending the course of ATG induction and continuing prednisone therapy in the vast majority of cases.
肾再次移植后的移植物存活率低于初次同种异体移植，尤其在接受尸体供肾（DD）的非裔美国人（AA）中。
在2001年7月至2007年7月间接受移植的166例AA DD肾移植受者中，我们比较了26例（16%）接受二次移植者与140例初次移植者的结局。所有患者均接受抗胸腺细胞球蛋白（ATG）或白细胞介素-2受体拮抗剂诱导治疗，并维持使用他克莫司或西罗莫司+霉酚酸酯±泼尼松。
与初次移植相比，再次移植受者接受的供肾来自年龄较大的供者，受者更年轻、致敏程度更高、更可能接受ATG且维持使用泼尼松，接受的ATG剂量更多，患糖尿病的可能性更小。初次移植组与再次移植组在总体患者或移植物存活率、急性排斥反应发生率、巨细胞病毒感染、BK肾病或新发糖尿病以及1年时的血清肌酐水平方面无差异。
通过延长ATG诱导疗程并在绝大多数病例中持续使用泼尼松治疗，AA肾移植受者尽管存在多种免疫和非免疫高危因素，仍可进行第二次DD移植，中期结局与初次移植相当。
