Sanfilippo F, Goeken N, Niblack G, Scornik J, Vaughn W K
Transplantation. 1987 Feb;43(2):240-4. doi: 10.1097/00007890-198702000-00015.
Data were collected retrospectively on all 449 first-transplant cadaver renal allograft recipients transplanted at four centers between 1/1/78 an 12/31/82 who had graft failure by 1/1/85. A total of 383 of these patients had information available regarding subsequent disposition. Of these, 182 (47.5%) were placed on an active waiting list for retransplantation. There were no associations found between placement on a waiting list and the following variables: panel reactive antibody (PRA) prior to first transplant or subsequent to graft failure, recipient age at first transplant or at the time of graft failure, recipient race, PRA after first graft loss, or HLA-A, B match of the first transplant. When stratified by level of HLA-A, B match as poor (0-1 antigen, n = 150) or good (2-4 antigens, n = 233) the poorly matched recipients as a group had a significantly lower mean PRA prior to first transplant (9.4 +/- 1.6 vs. 15.5 +/- 1.7, P less than 0.01), but a significantly higher PRA within the first year following graft failure (48.1 +/- 4.8 vs. 36.2 +/- 3.2, P less than 0.04). In addition, the poorly matched (vs. well-matched) group had a significantly higher mean increase in PRA following graft failure (45.1 +/- 4.4 vs. 33.7 +/- 3.5), and a significantly higher percentage of patients with PRA level greater than or equal to 60% within a year after graft failure (40% vs. 25%). Of the 182 patients who were placed on a waiting list, 113 (62.1%) were regrafted. As a group, regrafted patients had a significantly lower PRA within the first year following graft failure compared with the group not regrafted (33.6 +/- 3.9 vs. 54.0 +/- 5.0, P less than 0.002). Patients with a good first transplant HLA match had a higher overall regraft rate compared with those with a poor match (70.0% vs. 50.0%, P less than 0.01). Likewise, the percentage of well-matched patients regrafted within two years of first graft failure was significantly higher (55.5% vs. 32.5%, P less than 0.02). By multivariate analysis using the Cox proportional hazard model with 13 separate variables and considering all patients, the relative risk (RR) of not being regrafted was significantly (P less than 0.012) associated with poor HLA-A, B matching of the first transplant (RR = 1.7).(ABSTRACT TRUNCATED AT 400 WORDS)
对1978年1月1日至1982年12月31日期间在四个中心接受首次移植的449例尸体肾移植受者进行回顾性数据收集，这些受者在1985年1月1日前移植失败。其中共有383例患者有关于后续处置的可用信息。在这些患者中，182例（47.5%）被列入再次移植的活跃等待名单。在等待名单上的患者与以下变量之间未发现关联：首次移植前或移植失败后的群体反应性抗体（PRA）、首次移植时或移植失败时的受者年龄、受者种族、首次移植失败后的PRA，或首次移植的HLA - A、B配型。当按HLA - A、B配型水平分为差（0 - 1个抗原，n = 150）或好（2 - 4个抗原，n = 233）时，配型差的受者群体在首次移植前的平均PRA显著更低（9.4±1.6对15.5±1.7，P＜0.01），但在移植失败后的第一年内PRA显著更高（48.1±4.8对36.2±3.2，P＜0.04）。此外，配型差（与配型好相比）的群体在移植失败后的PRA平均升高显著更高（45.1±4.4对33.7±3.5），且移植失败后一年内PRA水平≥60%的患者百分比显著更高（40%对25%）。在被列入等待名单的182例患者中，113例（62.1%）再次移植。作为一个群体，再次移植的患者在移植失败后的第一年内的PRA显著低于未再次移植的群体（33.6±3.9对54.0±5.0，P＜0.002）。首次移植HLA配型良好的患者总体再次移植率高于配型差的患者（70.0%对50.0%，P＜0.01）。同样，配型良好的患者在首次移植失败后两年内再次移植的百分比显著更高（55.5%对32.5%，P＜
