ABO血型不相容肾移植受者持续较高的感染率：这是一个严重问题吗？单中心经验。

Ongoing higher infection rate in ABO-incompatible kidney transplant recipient: is it a serious problem? A single-center experience.

作者信息

Choi Byung Hyun, Han Duck Jong

机构信息

Division of Hepato-Biliary-Pancreatic Surgery and Transplantation, Department of Surgery, Pusan National University Yangsan Hospital, Pusan National University School of Medicine, Yangsan, Korea.; Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan, Korea.

Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.

出版信息

Ann Surg Treat Res. 2016 Jul;91(1):37-44. doi: 10.4174/astr.2016.91.1.37. Epub 2016 Jun 30.

DOI:10.4174/astr.2016.91.1.37

PMID:27433463

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC4942537/

Abstract

PURPOSE

Additional clinical experience and knowledge regarding the barrier to transplantation of ABO blood type incompatibility could reduce the higher rate of infectious complications in ABO-incompatible kidney transplantation.

METHODS

A total of 79 ABO-incompatible kidney transplantation (ABOiKT) patients were compared with 260 ABO-compatible kidney transplantation (ABOcKT) patients for basic clinical characteristics, infectious complications, rejection episodes, and graft survival.

RESULTS

There were no significant differences in baseline characteristics, rejection rates, or graft survival between the ABOiKT and ABOcKT patients. No significant difference in the infection rate was shown for cytomegalovirus (26.6% vs. 30.0%; P = 0.672), BK virus (19.0% vs. 21.5%; P = 0.752), herpes disease (10.1% vs. 5.0%; P = 0.082), pneumonia (5.3% vs. 3.8%; P = 0.746), or urinary tract infection (8.9% vs. 10.0%; P > 0.999). Female sex (hazard ratio [HR], 2.20; P = 0.003), advanced age (≥60 years) (HR, 2.5; P = 0.019), history of rejection episodes (HR, 2.28; P = 0.016), and history of surgical complications (HR, 4.64; P = 0.018) were significant risk factors for infection. ABO incompatibility demonstrated a tendency toward higher infection risk without statistical significance (HR, 1.74; P = 0.056).

CONCLUSION

In spite of immunosuppressant protocol modification, the rate of infectious complications following ABOiKT is still higher than with ABOcKT when a modified desensitization protocol is used. However, this was not sufficient to avoid ABOiKT.

摘要

目的

获取更多关于ABO血型不相容对移植造成障碍的临床经验和知识，可能会降低ABO血型不相容肾移植中较高的感染并发症发生率。

方法

将79例ABO血型不相容肾移植（ABOiKT）患者与260例ABO血型相容肾移植（ABOcKT）患者在基本临床特征、感染并发症、排斥反应发作及移植物存活情况方面进行比较。

结果

ABOiKT患者与ABOcKT患者在基线特征、排斥率或移植物存活方面无显著差异。巨细胞病毒感染率（26.6%对30.0%；P = 0.672）、BK病毒感染率（19.0%对21.5%；P = 0.752）、疱疹疾病感染率（10.1%对5.0%；P = 0.082）、肺炎感染率（5.3%对3.8%；P = 0.746）或尿路感染率（8.9%对10.0%；P > 0.999）均无显著差异。女性（风险比[HR]，2.20；P = 0.003）、高龄（≥60岁）（HR，2.5；P = 0.019）、排斥反应发作史（HR，2.28；P = 0.016）及手术并发症史（HR，4.64；P = 0.018）是感染的显著危险因素。ABO血型不相容显示出感染风险较高的趋势，但无统计学意义（HR，1.74；P = 0.056）。