Singh A, Stablein D, Tejani A
State University of New York, Health Science Center in Brooklyn, USA.
Transplantation. 1997 May 15;63(9):1263-7. doi: 10.1097/00007890-199705150-00012.
Vascular thrombosis remains a major cause of graft failure, accounting for 12.2% of failed index transplants and 19.2% of repeat transplants. We conducted a special study to identify the risk factors for vascular thrombosis. A total of 4394 transplants (2060 living donor [LD] transplants and 2334 cadaver donor [CAD] source transplants) were evaluated. The respective vascular thrombosis rates for LD and CAD transplants were 38/2060 (1.8%) and 100/2334 (4.2%) (P<0.001). Univariate analysis showed that the rate of graft loss due to thrombosis was significantly higher in younger children (less than 2 years of age) as compared with older age groups (2-5 years, 6-12 years, and more than 12 years of age) (9.0% vs. 5.5%, 4.4%, and 3.5% for CAD transplant recipients and 3.5% vs. 3.4%, 0.7%, and 1.9% for LD graft recipients). Recipients of kidneys from cadaver donors less than 5 years of age had a significantly higher thrombosis rate (8.3%) than did recipients from older donor groups (5-10 years, 4.5%; greater than 10 years, 3.2%). Recipients of kidneys with cold ischemia time greater than 24 hr also had a higher thrombosis rate (5.6%), as compared with recipients of kidneys with a shorter cold ischemia time (3.2%). Recipients of antilymphocyte therapy on day 0 or day 1 were at dimished risk of graft loss due to thrombosis (2.2% vs. 4.1%, P=0.001). Comparable trends were seen for both LD and CAD organ recipients. LD organ recipients with a history of prior transplantation had a significantly higher rate of thrombosis as compared with those who received a primary transplant (4.6% vs. 1.6%, P=0.005). For both LD and CAD organ recipients, the occurrence of acute tubular necrosis was a significnat risk factor for the development of thrombosis. Regression analysis showed that for LD organ recipients, a history of prior transplantation increased the risk for thrombosis, whereas increasing recipient age had a linear decreasing risk effect. The use of antilymphocyte antibody or cyclosporine on day 0/1 decreased the risk for thrombosis. For CAD kidney recipients, organ cold ischemia time greater than 24 hr increased the risk for thrombosis. The use of antibody induction therapy, donors greater than 5 years of age, and increasing recipient age were factors that decreased the risk for thrombosis.
血管血栓形成仍然是移植失败的主要原因，占初次移植失败的12.2%，再次移植失败的19.2%。我们进行了一项专项研究以确定血管血栓形成的危险因素。共评估了4394例移植手术（2060例活体供肾移植和2334例尸体供肾移植）。活体供肾移植和尸体供肾移植的血管血栓形成率分别为38/2060（1.8%）和100/2334（4.2%）（P<0.001）。单因素分析显示，与年龄较大组（2至5岁、6至12岁以及12岁以上）相比，年龄较小的儿童（小于2岁）因血栓形成导致的移植肾丢失率显著更高（尸体供肾移植受者中分别为9.0% vs. 5.5%、4.4%和3.5%；活体供肾移植受者中分别为3.5% vs. 3.4%、0.7%和1.9%）。年龄小于5岁的尸体供肾受者的血栓形成率（8.3%）显著高于年龄较大供者组的受者（5至10岁，4.5%；大于10岁，3.2%）。冷缺血时间大于24小时的肾移植受者的血栓形成率（5.6%）也高于冷缺血时间较短的受者（3.2%）。在第0天或第1天接受抗淋巴细胞治疗的受者因血栓形成导致移植肾丢失的风险降低（2.2% vs. 4.1%，P=0.001）。活体供肾和尸体供肾器官受者均呈现类似趋势。有既往移植史的活体供肾器官受者的血栓形成率显著高于接受初次移植的受者（4.6% vs. 1.6%，P=0.005）。对于活体供肾和尸体供肾器官受者而言，急性肾小管坏死的发生都是血栓形成的重要危险因素。回归分析显示，对于活体供肾器官受者，既往移植史增加血栓形成风险，而受者年龄增加则有线性降低风险的作用。在第0/1天使用抗淋巴细胞抗体或环孢素可降低血栓形成风险。对于尸体供肾肾移植受者，器官冷缺血时间大于24小时增加血栓形成风险。使用抗体诱导治疗、供者年龄大于5岁以及受者年龄增加都是降低血栓形成风险的因素。
