Saint Louis University Center for Outcomes Research, St. Louis, MO 63104, USA.
Transplantation. 2012 Aug 27;94(4):369-76. doi: 10.1097/TP.0b013e318259407f.
We examined the frequency and clinical impact of acute rejection (AR) in contemporary U.S. kidney transplantation.
Data for Medicare-insured kidney transplant recipients in 2000 to 2007 (n=48,179) were drawn from the United States Renal Data System. AR events were ascertained from Organ Procurement and Transplantation Network reports. AR was subclassified as antibody (Ab)-treated AR or other management (non-Ab-treated AR). Associations of AR with subsequent all-cause graft loss were estimated with time-varying Cox regression. Covariates included recipient, donor, and transplant factors in the United Network for Organ Sharing Kidney Allocation Review Committee survival model.
The frequencies of non-Ab-treated AR per 100 graft-years at risk among standard criteria donor recipients over the first 6, 12, 24, and 36 months after transplantation were 9.93, 8.43, 5.71, and 4.70, respectively. Non-Ab-treated AR was consistently more than twice as common as Ab-treated AR by risk period and donor type. Development of Ab-treated AR predicted a greater risk of graft loss than non-Ab-treated AR. The relative risk for graft loss from Ab-treated AR continuously increased with later timing of AR after transplantation, whereas risk associated with non-Ab-treated AR peaked for events reported in months 13 to 24 after kidney transplantation. Regardless of the diagnosis time, the relative risk of graft loss was higher in the first 89 days after a given AR report compared with 90 days and beyond.
AR events recognized later after transplantation have more serious graft loss implications, especially within the first 89 days after AR reporting. This observation may reflect reduced intensity of monitoring, delays in diagnosis, or clinicopathologic features of late AR.
我们研究了当代美国肾移植中急性排斥（AR）的频率和临床影响。
从美国肾脏数据系统中提取了 2000 年至 2007 年医疗保险承保的肾移植受者的数据（n=48179）。AR 事件是从器官获取和移植网络报告中确定的。将 AR 分为抗体（Ab）治疗性 AR 或其他管理（非 Ab 治疗性 AR）。使用时变 Cox 回归估计 AR 与随后的全因移植物丢失的相关性。协变量包括在联合器官共享网络肾脏分配审查委员会生存模型中的受者、供者和移植因素。
在移植后前 6、12、24 和 36 个月，标准标准供者受者每 100 个移植物年的非 Ab 治疗性 AR 频率分别为 9.93、8.43、5.71 和 4.70。非 Ab 治疗性 AR 的风险期和供者类型均明显多于 Ab 治疗性 AR。Ab 治疗性 AR 的发生预测移植物丢失的风险大于非 Ab 治疗性 AR。从 Ab 治疗性 AR 发生的时间延迟开始，移植物丢失的相对风险持续增加，而非 Ab 治疗性 AR 的风险则在移植后 13 至 24 个月报告的事件中达到峰值。无论诊断时间如何，与 AR 报告后 90 天及以后相比，在给定的 AR 报告后 89 天内，移植物丢失的相对风险更高。
移植后较晚时间识别的 AR 事件对移植物丢失的影响更严重，特别是在 AR 报告后的 89 天内。这种观察结果可能反映了监测强度降低、诊断延迟或晚期 AR 的临床病理特征。
