Martinez-Mier G, Enriquez-De Los Santos H, Méndez-López M T, Avila-Pardo S F, Budar-Fernandez L F, Gonzalez-Velazquez F
Organ Transplantation, Instituto Mexicano del Seguro Social, Unidad Medica de Alta Especialidad 189 ARC Veracruz, Nefrologia y Trasplantes de Veracruz, Veracruz, Mexico.
Transplant Proc. 2013 May;45(4):1442-4. doi: 10.1016/j.transproceed.2013.02.044.
Long-term graft function and survival are of particular importance in children assuming that they have a longer transplantation life span than most adults. Because acute rejection episodes (ARE) continue to have a serious impact on graft loss, we analyzed the effects of ARE on 5-year survival and function in our population. Fifty-seven living donor kidney transplant recipients (34 males) younger than 18 years of age (13.5 ± 2.6 years; range, 5-17) were follow up for at feast 12 months using cyclosporine, mycophenolate mofetil, and steroid therapy with or without induction treatment between February 2003 and December 2010. ARE incidence during the first 12 months following transplantation was 14%. One-, 3- and 5-year serum creatinine values were 1.24 ± 0.39, 2.16 ± 2.39, and 1.76 ± 0.9 mg/dL, respectively. Mean calculated creatinine clearances (Schwartz) at 1, 3, and 5 years were 82.5 ± 24.8, 64.7 ± 24.1, and 67 ± 27.5 mL/min*1.73 m(2), respectively. Patient/graft survival rates were 96/85%, 90/72%, and 88/65% at 1, 3, and 5 years, respectively. Patients who experienced an ARE within 12 months following transplantation displayed a reduced 5-year graft survival rate (37.5%) versus those who did not (78%; P = .005). Patients who did not have an ARE during 60 months had a higher graft survival rate (76%) than those who had ARE (33%; P = .001). Patient without basiliximab induction showed a lower 5-year graft survival rate (61% vs 100%; P = not significant [NS]). ARE is an important risk factor for graft loss in the pediatric kidney transplant population.
鉴于儿童的移植寿命比大多数成年人更长，长期移植功能和存活情况对他们尤为重要。由于急性排斥反应（ARE）持续对移植肾丢失产生严重影响，我们分析了ARE对我们研究人群中5年存活和功能的影响。2003年2月至2010年12月期间，对57例18岁以下（13.5±2.6岁；范围5 - 17岁）的活体供肾移植受者（34例男性）进行了至少12个月的随访，采用环孢素、霉酚酸酯和类固醇治疗，部分患者接受或未接受诱导治疗。移植后前12个月内ARE的发生率为14%。1年、3年和5年时的血清肌酐值分别为1.24±0.39、2.16±2.39和1.76±0.9mg/dL。1年、3年和5年时计算得出的平均肌酐清除率（施瓦茨公式）分别为82.5±24.8、64.7±24.1和67±27.5mL/min·1.73m²。患者/移植肾存活率在1年、3年和5年时分别为96/85%、90/72%和88/65%。移植后12个月内发生ARE的患者5年移植肾存活率（37.5%）低于未发生ARE的患者（78%；P = 0.005）。60个月内未发生ARE的患者移植肾存活率（76%）高于发生ARE的患者（33%；P = 0.001）。未接受巴利昔单抗诱导治疗的患者5年移植肾存活率较低（61%对100%；P = 无显著性差异[NS]）。ARE是小儿肾移植人群中移植肾丢失的重要危险因素。
