Tanabe K, Novick A C, Streem S, Hodge E
Department of Urology, Cleveland Clinic Foundation, Ohio 44195, USA.
Urology. 1995 Sep;46(3):321-7. doi: 10.1016/S0090-4295(99)80214-3.
The purpose of this study was to analyze the factors affecting long-term renal function in cyclosporine-treated kidney transplants.
The study population comprised 167 patients with more than 5 years of graft function on cyclosporine therapy. Patients were subdivided into those with a serum creatinine level 2.0 mg/dL or less (group I, n = 123) versus those with a level more than 2.0 mg/dL (group II, n = 44) at 5 years post-transplant. Patient survival, graft survival, rejection episodes, renal function, cyclosporine dose and trough level, and proteinuria were compared in these two groups.
There was no significant difference between groups I and II in terms of race, sex, donor source, donor age, primary renal disease, retransplants, transfusions, presensitization, histocompatibility locus antigen match, or initial nonfunction. At 6 months post-transplantation, the mean serum creatinine level in group II was significantly higher than group I (P = 0.00001), and this difference increased at subsequent follow-up intervals. The incidence of proteinuria was significantly higher in group II compared with group I (P < 0.001). Renal allograft survival beyond 5 years post-transplant was significantly better in group I compared with group II (P = 0.005). There was no significant difference in the mean cyclosporine dose or the mean cyclosporine trough level between groups I and II at any time following transplantation. The most important difference between groups I and II was the finding of significantly more early (P < 0.001) and late (P < 0.001) rejection episodes in group II.
These data suggest that long-term renal function in cyclosporine-treated kidney transplant patients is primarily influenced by the occurrence of early and late rejection episodes rather than by the dosage or duration of cyclosporine therapy.
本研究旨在分析影响接受环孢素治疗的肾移植受者长期肾功能的因素。
研究对象包括167例接受环孢素治疗且移植肾功能超过5年的患者。根据移植后5年时血清肌酐水平是否≤2.0mg/dL，将患者分为两组，血清肌酐水平≤2.0mg/dL者为I组（n = 123），>2.0mg/dL者为II组（n = 44）。比较两组患者的生存率、移植肾存活率、排斥反应发生率、肾功能、环孢素剂量和谷浓度以及蛋白尿情况。
I组和II组在种族、性别、供体来源、供体年龄、原发性肾脏疾病、再次移植、输血、致敏状态、组织相容性位点抗原匹配或初始无功能方面无显著差异。移植后6个月时，II组的平均血清肌酐水平显著高于I组（P = 0.00001），且在随后的随访期间该差异增大。II组蛋白尿发生率显著高于I组（P < 0.001）。移植后5年以上，I组的肾移植存活率显著高于II组（P = 0.005）。移植后任何时间，I组和II组的平均环孢素剂量或平均环孢素谷浓度均无显著差异。I组和II组之间最重要的差异是，II组早期（P < 0.001）和晚期（P < 0.001）排斥反应的发生率显著更高。
这些数据表明，接受环孢素治疗的肾移植患者的长期肾功能主要受早期和晚期排斥反应发生情况的影响，而非环孢素治疗的剂量或疗程。
