Cosio F G, Pelletier R P, Falkenhain M E, Henry M L, Elkhammas E A, Davies E A, Bumgardner G L, Ferguson R M
Division of Nephrology, The Ohio State University, Columbus 43210, USA.
Transplantation. 1997 Jun 15;63(11):1611-5. doi: 10.1097/00007890-199706150-00013.
Both acute rejection and the function of a renal allograft early after transplantation correlate with long-term graft survival. In this study we assessed the relationship between these two factors in 843 adult recipients of first cadaveric renal grafts, transplanted at a single institution and followed for a minimum of 3.5 years. Patients were divided into four groups according to (1) history of acute rejection (AR) during the first 6 months after transplantation, and (2) concentration of serum creatinine at 6 months after transplantation (SCr(6mo) < or > or = 2 mg/dl). Death censored allograft survival was not significantly different among patients without AR and with low SCr(6mo) (group 1, n=376), patients without AR but with an elevated SCr(6mo) (group 2, n=117), and patients with AR but low SCr(6mo) (group 3, n=185). In contrast, graft survival was significantly worse in patients with AR and an elevated SCr(6mo) (group 4, n=165) compared with patients in the other three groups (Cox, P<0.0001). The elevated SCr(6mo) in group 4 patients was not necessarily the consequence of AR, as 32% of patients in group 4 had a SCr at 10 days after transplantation (SCr(10d)), before they had AR, that was equal to or higher than the SCr(6mo). Based on this observation we investigated the implications of the SCr(10d) concentration for graft prognosis. The SCr(10d) correlated weakly with graft survival (Cox, P=0.05). However, an elevated SCr(10d) correlated with other potential risk factors for graft survival including: Older donors (P<0.0001), male recipients (P<0.0001), and heavier recipients (P<0.0001, all by multivariate regression); and posttransplant factors such as, increasing numbers of AR (P<0.0001), higher posttransplant blood pressure (P<0.0001), and lower doses of cyclosporine (P<0.0001, all by multivariate regression). In conclusion, graft dysfunction predicts poor graft survival only when associated with AR. Similarly, AR predicts a poor renal allograft survival only when associated with graft dysfunction. The SCr(10d) is an indicator of risk factors from both the donor and recipient, and an elevated SCr(10d) predicts a higher risk of acquiring additional risk factors early after transplantation.
急性排斥反应与肾移植术后早期移植肾的功能均与移植肾的长期存活相关。在本研究中，我们评估了843例首次接受尸体肾移植的成年受者中这两个因素之间的关系，这些受者均在同一机构接受移植，且随访时间至少为3.5年。根据以下两点将患者分为四组：（1）移植后前6个月内的急性排斥反应（AR）病史；（2）移植后6个月时的血清肌酐浓度（SCr(6mo) < 或 > 或 = 2 mg/dl）。在无AR且SCr(6mo)较低的患者（第1组，n = 376）、无AR但SCr(6mo)升高的患者（第2组，n = 117）以及有AR但SCr(6mo)较低的患者（第3组，n = 185）中，死亡删失的移植肾存活率无显著差异。相比之下，与其他三组患者相比，有AR且SCr(6mo)升高的患者（第4组，n = 165）的移植肾存活率显著更差（Cox检验，P < 0.0001）。第4组患者SCr(6mo)升高不一定是AR的结果，因为第4组中32%的患者在发生AR之前，移植后10天时的SCr（SCr(10d)）就已等于或高于SCr(6mo)。基于这一观察结果，我们研究了SCr(10d)浓度对移植肾预后的影响。SCr(10d)与移植肾存活率呈弱相关（Cox检验，P = 0.05）。然而，SCr(10d)升高与移植肾存活的其他潜在风险因素相关，包括：年龄较大的供者（P < 0.0001）、男性受者（P < 0.0001）以及体重较重的受者（均通过多因素回归分析，P < 0.0001）；以及移植后因素，如AR次数增加（P < 0.0001）、移植后血压升高（P < 0.0001）和环孢素剂量较低（均通过多因素回归分析，P < 0.0001）。总之，移植肾功能障碍仅在与AR相关时才预示移植肾存活不良。同样，AR仅在与移植肾功能障碍相关时才预示肾移植存活不良。SCr(10d)是供者和受者双方风险因素的一个指标，SCr(10d)升高预示移植后早期获得其他风险因素的风险更高。
