Gupta K L, Pattanashetti Navin, Ramachandran Raja, Nada Ritambhra, Aggarwal Ritu, Sharma Ashsish
From the Department of Nephrology, Postgraduate Institute of Medical Education and Research, Chandigarh, India.
Exp Clin Transplant. 2019 Jan;17(Suppl 1):78-82. doi: 10.6002/ect.MESOT2018.O14.
Improvements in early graft survival and long-term graft function have made kidney transplant a more cost-effective alternative to dialysis. We aimed to assess renal transplant outcomes over a 9-month follow-up of recipients in a cost-limited setting (a tertiary care center in India).
Included patients in this prospective observational study were those who underwent renal transplant from July 2016 to February 2017 (8 months) and followed for 9 months.
Of 122 included patients, 20 (16.4%) were women and 102 (83.6%) were men (mean age 35.61 ± 10.64 y), with 92 (75.4%) from a lower socioeconomic status. Kidneys were from first-degree relatives for 52 patients (42.6%), from spousal donors for 34 (27.9%), from deceased donors for 24 (19.7%), and from second/third degree relative donors for 12 (9.8%). All patients underwent only complementdependent cytotoxicity crossmatch due to financial constraints. Fifty patients (41%) had history of packed red blood cell transfusion. Induction was thymoglobulin in 60 patients (49.2%), basiliximab in 8 (6.6%), and no induction in 54 (44.3%). Forty patients (30.1%) underwent biopsy for graft dysfunction, and 32 (26.2%) had graft rejection: 18 (14.8%) with antibodymediated rejection, 5 (4.1%) with T-cell-mediated rejection, and 9 (7.4%) with both. Opportunistic infections were shown in 24.5% of patients, including primarily cytomegalovirus (10.7%), tuberculosis (5.7%), and aspergillosis (3.3%). Twenty-nine patients (24%) had new-onset diabetes posttransplant. At end of follow-up, 93 patients (76.2%) had normal graft function, 21 (17.2%) had chronic graft dysfunction, 3 (2.4%) had graft loss, and 5 (4.1%) died. History of blood transfusion (P = .001) predicted the occurrence of antibody-mediated rejection, and induction used showed trend toward prediction (P = .083).
With high rejection rates, it would be prudent to include proper immunologic testing, even in cost-limited settings, pretransplant. The high infection and death rates are also concerning.
早期移植物存活率和长期移植物功能的改善使肾移植成为比透析更具成本效益的选择。我们旨在评估在成本受限环境（印度一家三级医疗中心）中接受肾移植的受者9个月随访期内的肾移植结局。
这项前瞻性观察性研究纳入的患者为2016年7月至2017年2月（8个月）接受肾移植并随访9个月的患者。
在纳入的122例患者中，20例（16.4%）为女性，102例（83.6%）为男性（平均年龄35.61±10.64岁），其中92例（75.4%）来自社会经济地位较低的群体。52例患者（42.6%）的肾脏来自一级亲属，34例（27.9%）来自配偶供体，24例（19.7%）来自已故供体，12例（9.8%）来自二级/三级亲属供体。由于经济限制，所有患者仅进行了补体依赖细胞毒性交叉配型。50例患者（41%）有浓缩红细胞输血史。诱导治疗中60例患者（49.2%）使用了抗胸腺细胞球蛋白，8例（6.6%）使用了巴利昔单抗，54例（44.3%）未进行诱导治疗。40例患者（30.1%）因移植物功能障碍接受了活检，32例（26.2%）发生了移植排斥反应：18例（14.8%）为抗体介导的排斥反应，5例（4.1%）为T细胞介导的排斥反应，9例（7.4%）为两者均有。24.5%的患者出现机会性感染，主要包括巨细胞病毒（10.7%）、结核病（5.7%）和曲霉病（3.3%）。29例患者（24%）移植后新发糖尿病。随访结束时，93例患者（76.2%）移植物功能正常，21例（17.2%）有慢性移植物功能障碍，3例（2.4%）移植物丢失，5例（4.1%）死亡。输血史（P = 0.001）可预测抗体介导的排斥反应的发生，诱导治疗的使用显示出预测趋势（P = 0.083）。
由于排斥率较高，即使在成本受限的环境中，移植前进行适当的免疫检测也是谨慎之举。高感染率和死亡率也令人担忧。
