Stratta R J, Oh C S, Sollinger H W, Pirsch J D, Kalayoglu M, Belzer F O
Department of Surgery, University of Wisconsin School of Medicine, Madison 53792.
Transplantation. 1988 Jan;45(1):40-5.
The results of kidney retransplantation in the cyclosporine era remain to be determined. Over a 42-month period, 76 nonprimary renal transplants (66 second, 7 third, 3 fourth allografts) were performed in 73 recipients under cyclosporine immunosuppression. The patient population was predominantly white (90.4%) with a mean age of 32.3 years. Twenty-one recipients (28.8%) were diabetic, and 36 (49.3%) were highly sensitized (panel-reactive antibody [PRA] greater than 50%). Sixty-two patients received cadaver donor grafts while the remaining donations were living-related (12) or living-unrelated (2). A sequential antilymphocyte globulin/cyclosporine protocol was employed, with cyclosporine therapy delayed until adequate renal function occurred. Overall patient and graft survival is 92.1% and 60.5%, respectively, after a mean follow-up of 20.0 months. The mean serum creatinine is 1.64 mg/dl in the 46 functioning allografts. Graft survival is 63.6% for secondary grafts, 28.6% for tertiary grafts, and 66.7% for fourth kidney transplants. In second transplants, recipients of cadaver donor kidneys have a graft survival of 58.5%, while living-related donor graft survival is 84.6% (P = 0.07). In the cadaver retransplant population, duration of previous transplant function greater than one year and HLA-DR matching were associated with increased graft survival, while age over 39 and presence of diabetes mellitus with reduced graft survival. However, these trends were not significant. Peak PRA above 50% did demonstrate a significant negative impact on graft survival both in the univariate and multivariate analyses of risk factors. Acute rejection occurred in 50 patients (65.8%), and was successfully reversed 50% of the time. Of the 30 grafts lost, 25 (83.3%) occurred within four months of retransplantation. Transplant nephrectomy was performed in 20 patients. Cyclosporine was not administered in 21 (70%) of these early graft failures, negating any potential beneficial effect. Retransplantation can be performed safely, with living-donor graft survival superior to cadaver retransplant rates. Rejection and early graft loss are common, especially in the highly sensitized patient. The impact of cyclosporine immunosuppression in renal retransplantation is much less dramatic than in primary transplantation in a protocol that delays cyclosporine therapy until allograft function is demonstrated.
环孢素时代肾再次移植的结果仍有待确定。在42个月的时间里，73名接受者接受了76次非初次肾移植（66例第二次、7例第三次、3例第四次同种异体移植），均采用环孢素免疫抑制治疗。患者群体主要为白人（90.4%），平均年龄32.3岁。21名接受者（28.8%）患有糖尿病，36名（49.3%）高度致敏（群体反应性抗体[PRA]大于50%）。62例患者接受尸体供体移植，其余移植来自亲属活体（12例）或非亲属活体（2例）。采用序贯抗淋巴细胞球蛋白/环孢素方案，环孢素治疗延迟至肾功能恢复正常。平均随访20.0个月后，患者和移植肾总体存活率分别为92.1%和60.5%。46个功能正常的同种异体移植肾的平均血清肌酐为1.64mg/dl。第二次移植的移植肾存活率为63.6%，第三次移植为28.6%，第四次肾移植为66.7%。在第二次移植中，尸体供肾接受者的移植肾存活率为58.5%，而亲属活体供肾的移植肾存活率为84.6%（P = 0.07）。在尸体再次移植人群中，既往移植肾功能持续时间超过一年和HLA-DR配型与移植肾存活率增加相关，而年龄超过39岁和患有糖尿病则与移植肾存活率降低相关。然而，这些趋势并不显著。在危险因素的单因素和多因素分析中，PRA峰值高于50%确实对移植肾存活率有显著负面影响。50例患者（6
