Lytton B, Finkelstein F O, Schiff M, Black H R
Trans Am Assoc Genitourin Surg. 1975;67:99-102.
The clinical course was reviewed of 102 renal allograft recipients between December 1967 and December 1973. Only 4 of 21 patients (19 per cent) who had 2 or more episodes of rejection during the first 2 months had a functioning graft at the end of 1 year, compared to 24 of 30 patients (83 per cent) who had no rejection episodes. A similar trend was seen 2 to 6 months after transplantation. During the first 2 years vigorous immunosuppressive therapy for rejection in the first few months resulted in 12 deaths (44 per cent) of 27 patients. Subsequent to this immunosuppressive therapy was modified and grafts were removed if there was not a prompt recovery of function after treatment, which resulted in a significant decrease in mortality rate to 16 per cent. There also was improvement in the over-all survival of patients with functioning grafts from 37 to 56 per cent. Serious complications and mortality could be related to high dosage of steroids and severe leukopenia. A white blood count of less than 1,000 m m.3 on 3 successive days was associated with a mortality rate of 52 per cent, compared to 15 per cent in those without leukopenia. Serious consideration should be given to early graft removal in patients who have 2 or more episodes of rejection in the first few months after transplantation, particularly when there is not a prompt improvement in renal function after immunosuppressive therapy. High doses of steroids (greater than 1 mg. per kg. for more than 26 days during the first 60 days) should be avoided to decrease morbidity and mortality rates from serious infections. The results of histocompatibility (HL-A) matching in 72 donor-recipient pairs indicated an improved graft survival when there was a match of 2 or more antigens, which is supported by the results recently reported by the Transplant Registry. The results of mixed lymphocyte reactions in 20 live donor-recipient pairs showed a marked improvement in graft survival when there was less than 20 per cent stimulation and it appeared that this reaction was of more important prognostic significance than the results of histocompatibility (HL-A) matching in these patients.
回顾了1967年12月至1973年12月期间102例肾移植受者的临床病程。在最初2个月内发生2次或更多次排斥反应的21例患者中，只有4例（19%）在1年末移植肾仍有功能，而未发生排斥反应的30例患者中有24例（83%）移植肾有功能。移植后2至6个月也观察到类似趋势。在最初2年中，最初几个月针对排斥反应进行的强力免疫抑制治疗导致27例患者中有12例（44%）死亡。在此之后，免疫抑制治疗方案进行了调整，如果治疗后肾功能未迅速恢复，则切除移植肾，这使得死亡率显著下降至16%。有功能移植肾的患者总体生存率也从37%提高到了56%。严重并发症和死亡率可能与高剂量类固醇和严重白细胞减少有关。连续3天白细胞计数低于1000/mm³与52%的死亡率相关，而无白细胞减少的患者死亡率为15%。对于移植后最初几个月内发生2次或更多次排斥反应的患者，尤其是免疫抑制治疗后肾功能未迅速改善的患者，应认真考虑早期切除移植肾。应避免高剂量类固醇（在最初60天内超过26天每天大于1mg/kg）以降低严重感染导致的发病率和死亡率风险。72对供受者的组织相容性（HL - A）配型结果表明，当有2个或更多抗原匹配时，移植肾存活率有所提高，移植登记处最近报告的结果也支持这一点。20对活体供受者的混合淋巴细胞反应结果显示，当刺激率低于2
