Green Hefziba, Rahamimov Ruth, Rozen-Zvi Benaya, Pertzov Barak, Tobar Ana, Lichtenberg Shelly, Gafter Uzi, Mor Eytan
1 Department of Nephrology and Hypertension, Rabin Medical Center, Petah-Tikva, Israel. 2 Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel. 3 Department of Transplantation, Rabin Medical Center, Petah-Tikva, Israel. 4 Department of Internal Medicine E, Rabin Medical Center, Petah-Tikva, Israel. 5 Department of Pathology, Rabin Medical Center, Petah-Tikva, Israel.
Transplantation. 2015 Jun;99(6):1172-7. doi: 10.1097/TP.0000000000000459.
Most previously published studies of patients with membranoproliferative glomerulonephritis type I are small or have short follow-up period. We report the outcome of a fairly large cohort of patients followed up for nearly 10 years.
Retrospective cohort study. Graft survival, recurrence rate and risk factors for recurrence were analyzed for 43 patients transplanted between the years 1995 and 2012.
At a mean overall follow-up of 118 ± 61 months (median, 127.8; range, 4.9-217), 12 patients lost their graft (28%). Death-censored actuarial 15-year graft survival rate was 56%. Membranoproliferative glomerulonephritis recurred in eight patients (19%) at a median time of 15.4 months (range, 4.4-70 months). Recurrence led to graft loss in seven patients (88%) within a median of 11.6 months (range, 1.3-54 months) from diagnosis. Median graft survival was 30.5 months for recurrence (range, 7-86). Actuarial 15-year graft survival was 71% for nonrecurrent. The risk for recurrence was higher for patients with human leukocyte antigen (HLA) B49 (odds ratio, 16.9; 95% confidence interval, 1.1-246; P=0.038) and HLA DR4 (odds ratio, 15.9; 95% confidence interval, 1.07-237; P=0.044) alleles. A trend toward increased risk was found with shorter duration of dialysis before transplantation. Four of 16 (25%) living-related versus none of the living-unrelated donors' recipients recurred. The HLA B49, acute tubular necrosis after transplantation, previous transplantations, and Arab origin were all associated with decreased graft and patient survival.
Patients without recurrence in the first years should expect an excellent graft survival. Nonrelated living donors should be preferred. The HLA B49 and DR4 alleles may increase the risk for recurrence.
大多数先前发表的关于I型膜增生性肾小球肾炎患者的研究规模较小或随访期较短。我们报告了一组规模相当大的患者近10年的随访结果。
回顾性队列研究。分析了1995年至2012年间接受移植的43例患者的移植物存活率、复发率及复发的危险因素。
平均总随访时间为118±61个月（中位数为127.8个月；范围为4.9 - 217个月），12例患者移植肾失功（28%）。校正死亡后的15年移植肾存活率为56%。8例患者（19%）出现膜增生性肾小球肾炎复发，中位复发时间为15.4个月（范围为4.4 - 70个月）。复发导致7例患者（88%）在诊断后中位11.6个月（范围为1.3 - 54个月）内移植肾失功。复发患者的移植肾中位存活时间为30.5个月（范围为7 - 86个月）。未复发患者的校正死亡后的15年移植肾存活率为71%。携带人类白细胞抗原（HLA）B49等位基因（比值比为16.9；95%置信区间为1.1 - 246；P = 0.038）和HLA DR4等位基因（比值比为15.9；95%置信区间为1.07 - 237；P = 0.044）的患者复发风险更高。移植前透析时间较短者复发风险有增加趋势。16例活体亲属供肾受者中有4例（25%）复发，而活体非亲属供肾受者均未复发。HLA B49、移植后急性肾小管坏死、既往移植史及阿拉伯裔均与移植肾和患者存活率降低相关。
最初几年未复发的患者移植肾存活率有望良好。应优先选择非亲属活体供肾。HLA B49和DR4等位基因可能增加复发风险。
