Cosio F G, Qiu W, Henry M L, Falkenhain M E, Elkhammas E A, Davies E A, Bumgardner G L, Ferguson R M
Department of Internal Medicine, Ohio State University, Columbus 43210, USA.
Transplantation. 1996 Dec 15;62(11):1571-6. doi: 10.1097/00007890-199612150-00007.
In this study, we analyzed the relative impact of donor and recipient variables on cadaveric renal allograft function and survival. The unique feature of the study population is that each pair of recipients received their allografts from a single donor. The study includes 378 adult patients. In 129 pairs both recipients were Caucasian, and in 60 pairs one recipient was Caucasian and the other was African-American. All transplants were done in one center, thus minimizing differences in preservation time and providing uniform posttransplant management. The initial analysis showed a relationship between the function of the allograft 6 months after transplantation (serum creatinine [SCr]6 mo) and donor variables (P = 0.0004, analysis of variance). Furthermore, it was calculated that 64% of the variability in the SCr 6mo among patients was due to donor factors and 36% was due to recipient factors. An elevated SCr 6 mo was significantly associated with older donors, male recipients, and patients with acute rejection episodes. Furthermore, other unidentified donor factors may have an impact on allograft function. Reflecting the importance of donor factors, there was a significant relationship between SCr 6mo in paired recipients (P < 0.0008 by Spearman). Analysis of racially dissimilar pairs showed that the SCr 6mo and graft survival 6 months after transplantation were not significantly different between Caucasians and African-Americans. However, beyond 6 months, graft survival was worse in African-Americans (P < 0.0001 by Cox). Compared with Caucasians, graft survival was significantly worse in African-Americans with poorly controlled blood pressure (mean arterial pressure > 105 mmHg) (P = 0.002, Cox), but not in those patients with mean arterial pressure < 105 mmHg. In conclusion, donor factors are major determinants of renal allograft function. However, those factors may not be easily identifiable or quantifiable. Donor factors do not contribute to racial differences in allograft survival. However, poorly controlled hypertension correlates with poor renal graft survival in African-Americans.
在本研究中，我们分析了供体和受体变量对尸体肾移植功能及存活的相对影响。研究人群的独特之处在于，每对受体接受的同种异体移植肾均来自同一个供体。该研究纳入了378例成年患者。在129对受体中，两人均为白种人；在60对受体中，一人为白种人，另一人为非裔美国人。所有移植手术均在同一个中心进行，从而最大程度减少了保存时间的差异，并提供统一的移植后管理。初始分析显示，移植后6个月时同种异体移植肾的功能（血清肌酐[SCr]6个月时的值）与供体变量之间存在关联（方差分析，P = 0.0004）。此外，经计算，患者SCr 6个月时的值的64%的变异性归因于供体因素，36%归因于受体因素。SCr 6个月时的值升高与供体年龄较大、受体为男性以及发生急性排斥反应的患者显著相关。此外，其他未明确的供体因素可能对同种异体移植肾的功能有影响。反映供体因素的重要性的是，配对受体的SCr 6个月时的值之间存在显著关联（Spearman检验，P < 0.0008）。对种族不同的配对受体的分析显示，移植后6个月时白种人和非裔美国人的SCr 6个月时的值及移植肾存活情况无显著差异。然而，6个月之后，非裔美国人的移植肾存活情况较差（Cox检验，P < 0.0001）。与白种人相比，血压控制不佳（平均动脉压> 105 mmHg）的非裔美国人的移植肾存活情况显著较差（Cox检验，P = 0.002），但平均动脉压< 105 mmHg的患者并非如此。总之，供体因素是肾移植功能的主要决定因素。然而，这些因素可能不易识别或量化。供体因素不会导致移植肾存活的种族差异。然而，血压控制不佳与非裔美国人的肾移植存活情况较差相关。
