移植时较高的纤维胶凝蛋白-3水平是肾移植受者移植肾丢失的独立危险因素。

High ficolin-3 level at the time of transplantation is an independent risk factor for graft loss in kidney transplant recipients.

作者信息

Smedbråten Yuliya V, Sagedal Solbjørg, Mjøen Geir, Hartmann Anders, Fagerland Morten W, Rollag Halvor, Mollnes Tom Eirik, Thiel Steffen

机构信息

1 Department of Nephrology, Ullevål Oslo University Hospital, Oslo, Norway. 2 Department of Transplant Medicine, Rikshospitalet Oslo University Hospital, Oslo, Norway. 3 Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway. 4 Unit of Biostatistics and Epidemiology, Oslo University Hospital, Oslo, Norway. 5 Department of Microbiology, Rikshospitalet Oslo University Hospital, Oslo, Norway. 6 Department of Immunology, Oslo University Hospital Rikshospitalet, Oslo, Norway. 7 K.G Jebsen IRC, University of Oslo, Norway. 8 Research Laboratory, Nordland Hospital, Bodø, and Faculty of Health Sciences, University of Tromsø, Tromsø, Norway. 9 Department of Biomedicine, Aarhus University, Aarhus, Denmark.

出版信息

Transplantation. 2015 Apr;99(4):791-6. doi: 10.1097/TP.0000000000000422.

DOI:10.1097/TP.0000000000000422

PMID:25222012

Abstract

BACKGROUND

Recent studies have shown that activation of the complement system may be associated with long-term graft function. The aim of this retrospective study was to assess the impact of the pattern recognition molecules of the lectin pathway on long-term graft survival after kidney transplantation.

METHODS

Patients transplanted in 2000 to 2001 were included. Mannose-binding lectin, Ficolin-1, and Ficolin-3 were measured in serum at the time of transplantation. Data on death-censored graft loss were obtained from the Norwegian Renal Registry. Competing risks regression was used to investigate the association between time to graft loss and the explanatory variables. The variables were: high Ficolin-3 (upper quartile, ≥33.3 μg/mL) versus low Ficolin-3 (<33.3 μg/mL), acute rejection (time-dependent), age, basiliximab induction, sex, donor age, human leukocyte antigen mismatches, human leukocyte antigen antibodies, cold ischemia time, living donor, and preemptive transplantation.

RESULTS

A total of 382 patients with a median follow-up of 9.8 years were included. Sixty-six patients (17%) had death-censored graft loss, and 116 (30%) patients died. In a final competing risks model, high Ficolin-3 (subhazard ratio [SHR] = 1.95, P = 0.009), acute rejection (one vs. none) (SHR = 1.93, P = 0.033), acute rejection (two vs. none) (SHR = 5.45, P < 0.001), and age (SHR = 0.98, P = 0.006) were associated with death-censored graft loss. Basiliximab induction was associated with improved graft survival (SHR = 0.50, P = 0.016). No associations between mannose-binding lectin or Ficolin-1 and graft loss were found.

CONCLUSION

High Ficolin-3 level at the time of transplantation was an independent significant risk factor for shorter graft survival, even when adjusted for other covariates.

摘要

背景

近期研究表明，补体系统的激活可能与移植器官的长期功能有关。这项回顾性研究的目的是评估凝集素途径的模式识别分子对肾移植后移植器官长期存活的影响。

方法

纳入2000年至2001年接受移植的患者。在移植时检测血清中的甘露糖结合凝集素、纤维胶凝蛋白-1和纤维胶凝蛋白-3。从挪威肾脏登记处获取死亡删失的移植器官丢失数据。采用竞争风险回归分析移植器官丢失时间与解释变量之间的关联。这些变量包括：高纤维胶凝蛋白-3（上四分位数，≥33.3μg/mL）与低纤维胶凝蛋白-3（<33.3μg/mL）、急性排斥反应（时间依赖性）、年龄、巴利昔单抗诱导治疗、性别、供体年龄、人类白细胞抗原错配、人类白细胞抗原抗体、冷缺血时间、活体供体和抢先移植。

结果

共纳入382例患者，中位随访时间为9.8年。66例患者（17%）发生死亡删失的移植器官丢失，116例患者（30%）死亡。在最终的竞争风险模型中，高纤维胶凝蛋白-3（亚风险比[SHR]=1.95，P=0.009）、急性排斥反应（1次与无急性排斥反应相比）（SHR=1.9,3，P=0.033）、急性排斥反应（2次与无急性排斥反应相比）（SHR=5.45，P<0.001）和年龄（SHR=0.98，P=0.006）与死亡删失的移植器官丢失有关。巴利昔单抗诱导治疗与移植器官存活率提高有关（SHR=0.50，P=0.016）。未发现甘露糖结合凝集素或纤维胶凝蛋白-1与移植器官丢失之间存在关联。