移植前游离脂肪酸（FFA）与肾移植同种异体移植物存活。

Department of Surgery, University of California Davis Medical Center, Sacramento, California 95817, USA.

J Surg Res. 2010 Dec;164(2):182-7. doi: 10.1016/j.jss.2010.07.038. Epub 2010 Aug 17.

BACKGROUND

Fatty acids and their eicosanoid metabolites have been shown to be important mediators of the immune response in transplantation. We hypothesize that elevated pretransplant free fatty acids (FFA) levels may be associated with prolonged survival of kidney transplants.

METHODS

Archived pretransplant sera of 130 patients who received a kidney transplant from 1991 to 1997 were analyzed by gas liquid chromatography for a comprehensive FFA profile. FFA levels were categorized by quartiles, and the association between quartiles of the levels for each free-fatty acid and graft survival was initially screened by serial univariate analyses (Kaplan-Meier). All significant variables (FFAs and transplant-specific risk factors) were entered into a multivariable (Cox regression) model.

RESULTS

With > 10 y of follow-up, 68 kidney allografts were lost. Factors associated with decreased graft survival by univariate analysis included delayed graft function (DGF), acute rejection (AR), and cold ischemic time (CIT) > 24 h. High levels of arachidonic and γ-linolenic FFA were associated with higher graft survival rates. By multivariate analysis, only DGF, AR, CIT, and arachidonic acid levels were significant. The odds ratios for graft failure for the highest, third, and second quartiles of the pretransplant level of arachidonic acid, compared with the lowest quartile, were 0.18, 0.32, and 0.64, respectively (P = 0.050, log-rank test). For arachidonic acid the survival benefit appeared to be graded with the highest quartile associated with a greater than 80% reduction of risk of kidney graft failure.

CONCLUSION

Pretransplant level of arachidonic acid was independently associated with higher kidney graft survival rates. Further studies are necessary to identify the underlying mechanisms and to determine whether interventions aimed at increasing pretransplant arachidonic acid levels might prove beneficial for renal transplant outcomes.

背景

脂肪酸及其二十烷类代谢产物已被证明是移植免疫反应的重要介质。我们假设，移植前游离脂肪酸（FFA）水平升高可能与肾移植的存活时间延长有关。

方法

对 1991 年至 1997 年间接受肾移植的 130 例患者的存档移植前血清进行气相色谱分析，以获得全面的 FFA 图谱。根据四分位数对 FFA 水平进行分类，并通过单变量分析（Kaplan-Meier）对每种游离脂肪酸水平的四分位数与移植物存活率之间的关系进行初步筛选。将所有显著变量（FFA 和移植特异性危险因素）输入多变量（Cox 回归）模型。

结果

随访> 10 年后，68 例肾移植全部丧失功能。单变量分析中与移植物存活率降低相关的因素包括延迟移植物功能（DGF）、急性排斥反应（AR）和冷缺血时间（CIT）> 24 小时。花生四烯酸和γ-亚麻酸的高水平与更高的移植物存活率相关。多变量分析显示，只有 DGF、AR、CIT 和花生四烯酸水平是显著的。与最低四分位数相比，移植前花生四烯酸水平最高、第三和第二四分位数的移植失败的比值比分别为 0.18、0.32 和 0.64（P = 0.050，对数秩检验）。对于花生四烯酸，生存获益似乎呈梯度分布，四分位数值最高者与肾移植失败风险降低 80%以上相关。