Cosio F G, Dillon J J, Falkenhain M E, Tesi R J, Henry M L, Elkhammas E A, Davies E A, Bumgardner G L, Ferguson R M
Department of Internal Medicine, Ohio State University, Columbus, USA.
Kidney Int. 1995 Apr;47(4):1136-41. doi: 10.1038/ki.1995.162.
The rate of decline in the number of functioning renal allografts beyond the first year after transplantation has changed little in the last 25 years, and during long-term follow-up most allografts are lost due to chronic transplant rejection or patient death. The recipient race correlates with allograft survival, and African American recipients have a lower allograft survival than Caucasians. The goal of the present study was to identify clinical variables present during the first six months after transplantation that predict the loss of renal allografts beyond six months after transplantation, and in particular to determine the role of systemic hypertension on renal allograft survival in black and white recipients. This study includes 547 recipients of first cadaveric renal allografts performed at The Ohio State University. All patients were treated with a uniform immunosuppressive protocol and had a follow-up of at least three years. By multivariate analysis the following variables correlate with poor allograft survival: an elevated serum creatinine concentration measured six months after transplantation (SCr6mo) (P < 0.0001); black race (P < 0.0001); increasing numbers of acute rejection episodes (ATR) (P = 0.002); and young recipients (P = 0.026). Allograft survival is significantly worse in black (mean allograft half-life of 7.7 +/- 1.3 years) than in white recipients (24 +/- 3 years) (P < 0.0001). Black recipients also have a significantly higher six month average mean arterial blood pressure (MAP) (105 +/- 8 mm Hg) than white recipients (102 +/- 7 mm Hg) (P = 0.002). However, the prevalence of hypertension is not significantly different in black (33%) than in white recipients (26%).(ABSTRACT TRUNCATED AT 250 WORDS)
在过去25年里，移植后第一年以后有功能的肾移植数量的下降速率变化不大，在长期随访中，大多数移植肾因慢性移植排斥反应或患者死亡而丢失。受者种族与移植肾存活相关，非裔美国受者的移植肾存活率低于白种人。本研究的目的是确定移植后前六个月出现的临床变量，这些变量可预测移植后六个月以上肾移植的丢失，特别是确定系统性高血压在黑人和白人受者肾移植存活中的作用。本研究纳入了俄亥俄州立大学进行的首例尸体肾移植的547名受者。所有患者均接受统一的免疫抑制方案治疗，随访至少三年。多因素分析显示，以下变量与移植肾存活率低相关：移植后六个月测得的血清肌酐浓度升高（SCr6mo）（P<0.0001）；黑人种族（P<0.0001）；急性排斥反应发作次数增加（ATR）（P = 0.002）；以及年轻受者（P = 0.026）。黑人受者的移植肾存活率（平均移植肾半衰期为7.7±1.3年）明显低于白人受者（24±3年）（P<0.0001）。黑人受者六个月的平均平均动脉血压（MAP）（105±8 mmHg）也明显高于白人受者（102±7 mmHg）（P = 0.002）。然而，黑人受者（33%）的高血压患病率与白人受者（26%）相比无显著差异。（摘要截短于250字）
