Ingulli E, Matas A J, Nevins T E, Kashtan C E, Mauer S M, Gillingham K, Chavers B M
Department of Pediatrics, University of Minnesota, Minneapolis 55455, USA.
Pediatr Nephrol. 1996 Aug;10(4):474-8. doi: 10.1007/s004670050142.
Infants are thought to be more immunoreactive and at a greater risk for developing irreversible rejection compared with older children. We investigated this by analyzing patient and graft survival rates, incidence of acute rejection, reversibility of acute rejection, development of a subsequent acute rejection, and incidence of graft loss due to rejection in 154 children (< 18 years of age) after primary renal transplantation. Most patients (n = 139) were treated with quadruple immunosuppression (antibody, azathioprine, prednisone, cyclosporine). Treatment of the first acute rejection episode (ARE) consisted of antibody and increased prednisone (68%) or increased prednisone alone (30%), and was not significantly different between the age groups. Transplants were from living donors (LRD) in 80% of cases. Patients were followed for at least 1 year (mean 58 +/- 30 months); 68% (105/154) of recipients experienced 1 or more ARE. The incidence of ARE was significantly lower in patients < 2 years of age (45%) compared with patients 2-5 (76%, P = 0.01), 6-12 (78%, P = 0.005), and 13-17 (76%, P = 0.009) years of age. There was no significant difference in the 1-, 2- and 5-year patient or graft survival rates, the development of a subsequent acute rejection, or the incidence of graft loss due to acute rejection when analyzed by age group. These data suggest that the impact of an ARE is similar for younger and older children in our population receiving predominantly LRD transplants and quadruple immuno-suppression.
与大龄儿童相比，婴儿被认为免疫反应性更强，发生不可逆排斥反应的风险更高。我们通过分析154例初次肾移植术后的儿童（<18岁）的患者及移植物存活率、急性排斥反应发生率、急性排斥反应的可逆性、后续急性排斥反应的发生情况以及因排斥反应导致的移植物丢失发生率，对此进行了研究。大多数患者（n = 139）接受了四联免疫抑制治疗（抗体、硫唑嘌呤、泼尼松、环孢素）。首次急性排斥反应发作（ARE）的治疗包括抗体和增加泼尼松剂量（68%）或仅增加泼尼松剂量（30%），各年龄组之间无显著差异。80%的病例移植物来自活体供者（LRD）。患者至少随访1年（平均58±30个月）；68%（105/154）的受者经历了1次或更多次ARE。<2岁患者的ARE发生率（45%）显著低于2 - 5岁（76%，P = 0.01）、6 - 12岁（78%，P = 0.005）和13 - 17岁（76%，P = 0.009）的患者。按年龄组分析时，1年、2年和5年的患者或移植物存活率、后续急性排斥反应的发生情况以及因急性排斥反应导致的移植物丢失发生率均无显著差异。这些数据表明，在我们这个以LRD移植和四联免疫抑制为主的人群中，ARE对年幼儿童和大龄儿童的影响相似。
