Fadli Saâd Ed-Dine, Pernin Vincent, Nogue Erika, Macioce Valérie, Picot Marie-Christine, Ramounau-Pigot Annie, Garrigue Valérie, Iborra François, Mourad Georges, Thuret Rodolphe
Department of Urology and Transplantation, University Hospital of Montpellier, Montpellier, France.
Int J Urol. 2014 Aug;21(8):797-802. doi: 10.1111/iju.12455. Epub 2014 Apr 13.
To determine the impact of renal graft nephrectomy on second kidney transplantation survival.
We carried out a retrospective single-center study by analyzing cases performed from January 2000 to December 2011. Retransplanted patients who underwent previous allograft nephrectomy more than 3 months post-transplantation (group 1) were compared with those who did not (group 2) in terms of graft survival, incidences of acute rejection and delayed graft function. Multivariate Cox proportional hazard models were used to assess risk factors of graft loss after retransplantation.
Overall, 146 patients were analyzed, including 52 (35.6%) in group 1 and 94 (64.4%) in group 2. Group 1 patients presented a significantly shorter first graft survival (0.8 vs 8.6 years, P < 0.001) and more anti-class I antibodies (90.5% vs 74.2%, P = 0.03). A total of 10 patients (19%) in group 1 and 16 patients (17%) in group 2 had at least one acute rejection episode (P = 0.74). Delayed graft function was observed in 13 patients (25%) in group 1 and 17 patients (18%) in group 2 (P = 0.32). Graft survival at 1, 5 and 10 years was, respectively, 94%, 81% and 58% in group 1, and 99%, 93% and 66% in group 2 (P = 0.10). Graft survival was decreased by increased donor age and serum creatinine, and tended to be associated with post-transplantation presence of anti-class I and II antibodies. Graft nephrectomy was not associated with graft survival in multivariate analysis.
Graft nephrectomy, probably a marker of high immunological risk patients, is not a risk factor of increased retransplant failure.
确定肾移植肾切除术对二次肾移植存活的影响。
我们通过分析2000年1月至2011年12月期间进行的病例开展了一项回顾性单中心研究。将移植后3个月以上接受过同种异体移植肾切除术的再次移植患者（第1组）与未接受过的患者（第2组）在移植肾存活、急性排斥反应发生率和移植肾功能延迟方面进行比较。采用多变量Cox比例风险模型评估再次移植后移植肾丢失的危险因素。
总体上，分析了146例患者，其中第1组52例（35.6%），第2组94例（64.4%）。第1组患者首次移植肾存活时间显著较短（0.8年对8.6年，P<0.001），且抗I类抗体更多（90.5%对74.2%，P=0.03）。第1组共有10例患者（19%）和第2组16例患者（17%）发生至少一次急性排斥反应（P=0.74）。第1组13例患者（25%）和第2组17例患者（18%）观察到移植肾功能延迟（P=0.32）。第1组1年、5年和10年的移植肾存活率分别为94%、81%和58%，第2组分别为99%、93%和66%（P=0.10）。移植肾存活率因供体年龄和血清肌酐升高而降低，并且往往与移植后抗I类和II类抗体的存在有关。在多变量分析中，移植肾切除术与移植肾存活无关。
移植肾切除术可能是高免疫风险患者（的一个标志），但不是再次移植失败增加的危险因素。
