慢性移植肾功能不全的肾移植受者长期移植肾失功的危险因素。

Risk factors of long-term graft loss in renal transplant recipients with chronic allograft dysfunction.

作者信息

Khalkhali Hamid Reza, Ghafari Ali, Hajizadeh Ebrahim, Kazemnejad Anoushirvan

机构信息

University Department of Biostatistics, Department of Internal Medicine.

出版信息

Exp Clin Transplant. 2010 Dec;8(4):277-82.

PMID:21143092

Abstract

OBJECTIVES

Graft loss owing to chronic allograft dysfunction is a major concern in renal transplant recipients. We assessed the affect of immune and nonimmune risk factors on death-censored graft loss in renal transplant recipients with chronic allograft dysfunction.

MATERIALS AND METHODS

We performed a retrospective, single-center study on 214 renal transplant recipients with chronic allograft dysfunction among 1534 renal transplant recipients at the Urmia University Hospital from 1997 to 2005. Data registry includes details from all renal transplants. The renal transplant recipient information is regularly updated to determine current graft function, graft loss, or renal transplant recipient's death. The selection criteria were a functional renal allograft for at least 1 year and a progressive decline in allograft function.

RESULTS

Increasing donor age (RR=1.066; P < .001), recipient age (RR=1.021, P = .00), recipient weight (RR=1.024; P = .029), and waiting time on dialysis to transplant (RR=1.047; P = .006), pretransplant hypertension (RR=3.126; P < .001), pretransplant diabetes (RR=5.787; P < .001), delayed graft function (RR=6.087; P < .001), proteinuria (RR=2.663; P = .001), posttransplant diabetes (RR=2.285; P = .015), posttransplant hypertension (RR=2.047; P = .017), and AR (RR=3.125; P < .001). Patients in stage 2 at the beginning of chronic allograft dysfunction relative to stage 1 (RR=4.823; P < .001) and patients in stage 3 at the beginning of chronic allograft dysfunction relative to stage 1 (RR=123.06; P < .001) were significant risk factors for death-censored graft loss. Using mycophenolate mofetil versus azathioprine reduced death-censored graft loss (RR=0.499; P = .001).

CONCLUSION

We found that age of donor, pretransplant hypertension, pretransplant diabetes, type of immunosuppression (mycophenolate mofetil vs azathioprine), delayed graft function, proteinuria, and stage of allograft dysfunction at the start of chronic allograft dysfunction are the major risk factors for late renal allograft dysfunction.

摘要

目的

慢性移植肾失功导致的移植肾丢失是肾移植受者的主要担忧。我们评估了免疫和非免疫风险因素对慢性移植肾失功的肾移植受者死亡删失移植肾丢失的影响。

材料与方法

我们对1997年至2005年在乌尔米亚大学医院的1534例肾移植受者中的214例慢性移植肾失功患者进行了一项回顾性单中心研究。数据登记包括所有肾移植的详细信息。定期更新肾移植受者信息以确定当前移植肾功能、移植肾丢失或肾移植受者死亡情况。选择标准为功能性移植肾至少1年且移植肾功能进行性下降。

结果

供者年龄增加（相对危险度[RR]=1.066；P<.001）、受者年龄（RR=1.021，P=.00）、受者体重（RR=1.024；P=.029）、透析等待时间至移植（RR=1.047；P=.006）、移植前高血压（RR=3.126；P<.001）、移植前糖尿病（RR=5.787；P<.001）、移植肾功能延迟恢复（RR=6.087；P<.001）、蛋白尿（RR=2.663；P=.001）、移植后糖尿病（RR=2.285；P=.015）、移植后高血压（RR=2.047；P=.017）以及急性排斥反应（RR=3.125；P<.001）。慢性移植肾失功开始时处于2期的患者相对于1期（RR=4.823；P<.001）以及慢性移植肾失功开始时处于3期的患者相对于1期（RR=123.06；P<.001）是死亡删失移植肾丢失的显著危险因素。使用霉酚酸酯对比硫唑嘌呤可降低死亡删失移植肾丢失（RR=0.499；P=.001）。