Sanfilippo F, Vaughn W K, Lefor W M
Clin Transpl. 1986:109-20.
Since the introduction of CsA in 1983, several changes in SEOPF activity have been observed: 1. Organ recovery has increased at a rate slower than candidate registration, whereas the utilization rate has increased substantially. 2. Overall organ sharing has decreased for both CsA and non-CsA-treated patients. 3. The percentage of poor HLA-A,B matched recipients has increased for both CsA- and non-CsA-treated patients. 4. The use of cold storage preservation has increased for both CsA- and non-CsA-treated patients. 5. The use of ALS has decreased, predominantly in CsA-treated patients. 6. A majority of diabetics are being treated with CsA. 7. There is substantial individual variation in SEOPF center preferences for CsA use, HLA matching, and use of shared kidneys. In terms of graft outcome, the following associations have been observed: 1. The incidence of delayed graft function has increased with shared kidneys only, suggesting sharing of poorer quality as well as fewer kidneys. 2. First transplant recipients receiving CsA tend to have lower delayed graft function rates, possibly as a result of treatment selection. However, the risk of graft failure associated with delayed function is greater in patients receiving CsA. 3. By univariate analysis, there is an additive benefit of HLA-A,B matching and CsA use in patients receiving local kidneys with immediate function. 4. By multivariate analysis, there is a significant relative risk of graft rejection associated with poor HLA-A,B matching in patients receiving CsA. 5. By multivariate analysis, there is an apparent risk of graft loss associated with shared organs, but only in patients receiving CsA. One possible explanation is that poorer quality kidneys are being accepted for patients treated with CsA. 6. By multivariate subset analysis, there is a significant benefit of CsA use in patients whose HLA is poorly matched, but no observed benefit in well-matched patients. 7. Definitive evaluation of the relative effects of CsA and HLA matching on cadaver renal allograft survival must await long-term follow-up data on survival and function, and the ability to control for center bias in sharing, HLA matching, and CsA use.
自1983年环孢素（CsA）引入以来，已观察到尸体供肾器官移植项目（SEOPF）活动有多项变化：1. 器官回收率有所增加，但其增速低于候选者登记率，而利用率则大幅提高。2. 环孢素治疗组和非环孢素治疗组患者的总体器官共享率均有所下降。3. 环孢素治疗组和非环孢素治疗组中HLA - A、B配型不佳的受者比例均有所增加。4. 环孢素治疗组和非环孢素治疗组患者使用冷保存的情况均有所增加。5. 抗淋巴细胞血清（ALS）的使用减少，主要是在环孢素治疗的患者中。6. 大多数糖尿病患者接受环孢素治疗。7. SEOPF各中心在环孢素使用、HLA配型和共用肾脏使用方面存在很大的个体差异。就移植结果而言，已观察到以下关联：1. 仅共用肾脏时移植肾功能延迟的发生率增加，这表明共用肾脏的质量较差且数量较少。2. 接受环孢素治疗的首次移植受者往往移植肾功能延迟发生率较低，这可能是治疗选择的结果。然而，接受环孢素治疗的患者中，与移植肾功能延迟相关的移植失败风险更大。3. 单因素分析显示，对于移植后立即有功能的接受本地肾脏的患者，HLA - A、B配型和使用环孢素具有累加益处。4. 多因素分析显示，接受环孢素治疗的患者中，HLA - A、B配型不佳与移植排斥的相对风险显著相关。5. 多因素分析显示，共用器官与移植失败的明显风险相关，但仅在接受环孢素治疗的患者中存在。一种可能的解释是，接受环孢素治疗的患者接受了质量较差的肾脏。6. 多因素亚组分析显示，HLA配型不佳的患者使用环孢素具有显著益处，但在配型良好的患者中未观察到益处。7. 关于环孢素和HLA配型对尸体肾移植存活的相对影响的确定性评估，必须等待关于存活和功能的长期随访数据，以及控制共享、HLA配型和环孢素使用中的中心偏倚的能力。
