Eid Loai, Tuchman Shamir, Moudgil Asha
Department of Nephrology, Children's National Medical Center, Washington, DC, USA.
Pediatr Transplant. 2014 Mar;18(2):155-62. doi: 10.1111/petr.12203. Epub 2013 Dec 28.
Long-term graft survival and function has not kept pace with short-term success in kidney transplant (Tx) recipients. LAR ≥6 months post-Tx may contribute to lack of improvement; risk factors for LAR are not well known. Of 64 Tx recipients followed over six yr, 23 (35.9%) had LAR (LAR group) and 41 had no LAR (no LAR group). Of all variables, significant risk factors for LAR included DGF, (43.4% LAR vs. 14.6% in no LAR group, p = 0.0096); de novo DSA (65.2% vs. 26.8%, p = 0.003); mean COV% of TAC (41.8% vs. 34.6%, p = 0.03); and non-adherence (34.8% vs. 7.3%, p = 0.0043). DGF and DSA remained statistically significant (p = 0.002 and 0.003, respectively); COV% TAC had borderline significance (p = 0.057), and non-adherence was not significant on multivariate regression analysis. Patients with LAR had inferior graft survival and function, whereas graft function was stable in the no LAR group over a mean follow-up of 31.2 months. Patients with de novo DSA and DGF should be considered at risk of LAR; an early diagnosis and treatment of LAR may improve graft survival and function.
肾移植（Tx）受者的长期移植物存活和功能并未跟上短期成功的步伐。移植后6个月以上的延迟移植肾功能恢复（LAR）可能导致改善不足；LAR的危险因素尚不清楚。在64名随访6年的Tx受者中，23名（35.9%）出现LAR（LAR组），41名未出现LAR（无LAR组）。在所有变量中，LAR的显著危险因素包括移植肾功能延迟恢复（DGF）（LAR组为43.4%，无LAR组为14.6%，p = 0.0096）；新发供者特异性抗体（DSA）（65.2%对26.8%，p = 0.003）；他克莫司（TAC）的平均变异系数百分比（COV%）（41.8%对34.6%，p = 0.03）；以及不依从（34.8%对7.3%，p = 0.0043）。DGF和DSA在统计学上仍具有显著性（分别为p = 0.002和0.003）；TAC的COV%具有临界显著性（p = 0.057），且不依从在多变量回归分析中无显著性。出现LAR的患者移植物存活和功能较差，而在平均31.2个月的随访中，无LAR组的移植物功能稳定。新发DSA和DGF的患者应被视为有LAR风险；LAR的早期诊断和治疗可能改善移植物存活和功能。
