Kaufman D B, Sutherland D E, Fryd D S, Ascher N L, Simmons R L, Najarian J S
Department of Surgery, University of Minnesota, Minneapolis 55455.
Transplantation. 1988 Jun;45(6):1045-9. doi: 10.1097/00007890-198806000-00009.
The beneficial effects of pretransplant blood transfusions on the success rate of renal transplantation have been so overwhelmingly emphasized that there is virtually no information on the fate of grafts in nontransfused patients transplanted during the last decade. Since 1979, all patients who have undergone renal transplantation at the University of Minnesota have routinely received random blood transfusions except Jehovah's Witnesses. Jehovah's Witnesses refuse transfusions but will accept renal allografts. From 1979 to May 30, 1987, primary renal allografts were placed in thirteen nontransfused Jehovah's Witnesses; six patients received kidneys from mismatched living-related donors, two patients received HLA-identical sibling grafts, and five patients received cadaveric renal allografts. The range of follow-up of the thirteen patients was 3-93 months, with a mean of 45 months and a median of 50 months. The outcomes after renal transplantation in Jehovah's Witnesses were compared with those of a paired control group (n = 25) matched for age, date of transplant, donor source, and diabetic status. The overall three-year actuarial patient and graft survival rates of the Jehovah's Witnesses were 83 per cent and 66 per cent, versus 80 per cent and 77 per cent for the controls. Although the outcomes after renal transplantation in Jehovah's Witnesses were similar to those of the control group, the Jehovah's Witnesses had an increased susceptibility to rejection episodes. The cumulative percentage of incidence of primary rejection episodes was 77 per cent at three months in the Jehovah's Witnesses versus 44 per cent at 21 months in the matched control group. The consequence of early allograft dysfunction from rejection was particularly detrimental to Jehovah's Witnesses who developed severe anemia (hemoglobin (Hgb)* 4.5 g per cent)-two early deaths occurred in the subgroup with this combination of problems. The overall results suggest that renal transplantation can be safely and efficaciously applied to most Jehovah's Witnesses but those with anemia who undergo early rejection episodes are a high-risk group relative to other transplant patients.
移植前输血对肾移植成功率的有益影响已被过分强调，以至于几乎没有关于过去十年间未输血患者移植肾命运的信息。自1979年以来，明尼苏达大学所有接受肾移植的患者，除耶和华见证会成员外，都常规接受随机输血。耶和华见证会成员拒绝输血，但会接受同种异体肾移植。从1979年到1987年5月30日，13名未输血的耶和华见证会成员接受了初次同种异体肾移植；6名患者接受了不匹配的亲属活体供肾，2名患者接受了HLA相同的同胞供肾，5名患者接受了尸体肾移植。这13名患者的随访时间为3至93个月，平均45个月，中位数50个月。将耶和华见证会成员肾移植后的结果与配对对照组（n = 25）进行比较，对照组在年龄、移植日期、供体来源和糖尿病状态方面与之匹配。耶和华见证会成员三年的患者总体精算生存率和移植肾生存率分别为83%和66%，而对照组分别为80%和77%。虽然耶和华见证会成员肾移植后的结果与对照组相似，但他们发生排斥反应的易感性增加。耶和华见证会成员在三个月时初次排斥反应的累积发生率为77%，而配对对照组在21个月时为44%。排斥反应导致的早期移植肾功能障碍对发生严重贫血（血红蛋白（Hgb）*4.5克/分升）的耶和华见证会成员尤其有害——在出现这种问题组合的亚组中有2例早期死亡。总体结果表明，肾移植对大多数耶和华见证会成员来说是安全有效的，但与其他移植患者相比，那些发生早期排斥反应且伴有贫血的患者是高危人群。 *血红蛋白（Hgb）
