Boonstra J G, Bruijn J A, Hermans J, Lemkes H H, Ringers J, van der Pijl H, van der Woude F J
Department of Nephrology, University Hospital Leiden, The Netherlands.
J Am Soc Nephrol. 1995 May;5(11):1918-25. doi: 10.1681/ASN.V5111918.
Several groups have reported that recipients of a simultaneous pancreas-kidney transplantation suffer from more kidney rejection episodes than do recipients of a kidney transplantation (1-6). However, it is not known whether this is interstitial rejection, vascular rejection, or both. In this study, the renal biopsies and transplantectomies of 45 pancreas-kidney and 48 kidney transplant recipients were evaluated for the presence of interstitial and vascular rejection. Furthermore, the influence of OKT3 induction therapy on rejection after pancreas-kidney transplantation was studied. Of the 45 pancreas-kidney recipients. 4 patients did not suffer from rejection during follow-up, 28 suffered only from interstitial rejection, and 13 suffered from vascular (with or without interstitial) rejection, whereas 12, 19, and 14 of the 48 kidney transplant patients had no rejection, interstitial rejection, or vascular (with or without interstitial) rejection, respectively. Three patients with a kidney transplant were treated for rejection although no biopsy was taken. In the pancreas-kidney group, 38 of the total of 149 biopsies and transplantectomies taken contained no rejection, 92 had interstitial rejection, and 19 had vascular rejection. In the kidney group, these values were 13, 41, and 25, respectively, of 79 biopsies and transplantectomies taken (P = 0.002). Five-year renal graft survival was 79% in the kidney group and 60% in the pancreas-kidney group. Renal graft survival rates differed significantly (P = 0.02). Renal graft survival and occurrence of rejection did not reach significance between pancreas-kidney recipients treated with OKT3 induction therapy and pancreas-kidney recipients receiving conventional triple therapy.(ABSTRACT TRUNCATED AT 250 WORDS)
多个研究小组报告称，同时接受胰腺-肾脏移植的受者比接受肾脏移植的受者经历更多的肾脏排斥反应（1-6）。然而，尚不清楚这是间质排斥、血管排斥，还是两者皆有。在本研究中，对45例胰腺-肾脏移植受者和48例肾脏移植受者的肾活检及移植肾切除术标本进行评估，以确定是否存在间质排斥和血管排斥。此外，还研究了OKT3诱导治疗对胰腺-肾脏移植后排斥反应的影响。在45例胰腺-肾脏移植受者中，4例在随访期间未发生排斥反应，28例仅发生间质排斥，13例发生血管排斥（伴有或不伴有间质排斥）；而在48例肾脏移植受者中，分别有12例、19例和14例未发生排斥反应、发生间质排斥或血管排斥（伴有或不伴有间质排斥）。3例肾脏移植受者虽未进行活检，但接受了排斥反应治疗。在胰腺-肾脏移植组，149例活检及移植肾切除术标本中，38例未发现排斥反应，92例存在间质排斥，19例存在血管排斥。在肾脏移植组，79例活检及移植肾切除术标本中，这些数值分别为13例、41例和25例（P = 0.002）。肾脏移植组的5年肾移植存活率为79%，胰腺-肾脏移植组为60%。肾移植存活率差异有统计学意义（P = 0.02）。接受OKT3诱导治疗的胰腺-肾脏移植受者与接受传统三联疗法的胰腺-肾脏移植受者之间，肾移植存活率及排斥反应发生率无显著差异。（摘要截选至250词）
