Organ Transplantation Unit, The Surgical Division, Tel Aviv Sourasky Medical Center, and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
Department of Nephrology, Tel Aviv Sourasky Medical Center, and Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel.
Transpl Int. 2019 Jul;32(7):730-738. doi: 10.1111/tri.13415. Epub 2019 Mar 10.
Inflammatory bowel diseases (IBD) is a systemic disorder with possible renal involvement, yet data regarding the outcome of kidney transplantation (KT) in those patients, and IBD course post KT, are scarce. In this retrospective analysis, we studied the outcome of 12 IBD kidney recipients (seven Crohn's disease, five ulcerative colitis; primary kidney disease was IgA nephropathy in five, polycystic disease in four), compared to two control groups: matched controls and a cohort of recipients with similar kidney disease. During a follow-up period of 60.1 (11.0-76.6) months (median, interquartile range), estimated 5-year survival was 80.8 vs. 96.8%, with and without IBD, respectively (P = 0.001). Risk of death with a functioning graft was higher with IBD (HR = 1.441, P = 0.048), and with increased age (HR = 1.109, P = 0.05). Late rehospitalization rate was higher in IBD [incidence rate ratio = 1.168, P = 0.030], as well as rate of hospitalization related to infection [1.42, P = 0.037]. All patients that were in remission before KT, remission was maintained. Patients that were transplanted with mild or moderate disease remained stable or improved with Infliximab or Adalimumab treatment. In conclusion, IBD is associated with an increased risk of mortality, hospitalization because of infection and late rehospitalization after KT. Clinical course of IBD is stable after KT.
炎症性肠病（IBD）是一种全身性疾病，可能伴有肾脏受累，然而，关于这些患者的肾移植（KT）结局以及 IBD 在 KT 后的病程的数据仍然很少。在这项回顾性分析中，我们研究了 12 例 IBD 肾移植受者（7 例克罗恩病，5 例溃疡性结肠炎；原发性肾病为 5 例 IgA 肾病，4 例多囊肾病）的结局，并与 2 个对照组进行了比较：匹配对照组和具有相似肾病的受者队列。在 60.1（11.0-76.6）个月（中位数，四分位距）的随访期间，无 IBD 组和有 IBD 组的估计 5 年生存率分别为 80.8%和 96.8%（P = 0.001）。有 IBD 时，带功能移植物的死亡风险更高（HR = 1.441，P = 0.048），且年龄越大（HR = 1.109，P = 0.05）风险越高。IBD 组的晚期再住院率更高[发病率比 = 1.168，P = 0.030]，感染相关住院率也更高[1.42，P = 0.037]。所有在 KT 前处于缓解期的患者，缓解期得以维持。接受轻度或中度疾病移植的患者，在使用英夫利昔单抗或阿达木单抗治疗后病情稳定或改善。总之，IBD 与 KT 后死亡率、感染相关住院率和晚期再住院率增加有关。KT 后 IBD 的临床病程稳定。
