Birk P E, Matas A J, Gillingham K J, Mauer S M, Najarian J S, Chavers B M
Department of Pediatrics, University of Minnesota, Minneapolis 55455-0392, USA.
Pediatr Nephrol. 1997 Aug;11(4):395-8. doi: 10.1007/s004670050303.
Chronic rejection (CR) is the most common cause of graft loss beyond the 1st posttransplant year. The aim of this analysis was to identify the risk factors for the development of CR in pediatric renal transplant recipients. Between June 1984 and March 1994, 217 renal transplants were performed in children at our center. Immunosuppression included prednisone, azathioprine, cyclosporine (CsA), and prophylactic antibody. Using multivariate analysis, we studied the impact of the following variables on the development of biopsy-proven CR: age at transplant (< or = 5 years, > 5 years), gender, race, transplant number (primary, retransplant), donor source (cadaver, living donor), donor age (< 20 years, 20-49 years, > 49 years), number of ABDR mismatches (0, 1-2, 3-4, 5-6), number of DR mismatches (0, 1, 2), percentage peak panel reactive antibody (PRA) (< or = 50%, > 50%), percentage PRA at transplantation (< or = 50%, > 50%), dialysis pretransplant, preservation time > 24 h, acute tubular necrosis requiring dialysis, initial CsA dosage (< or = 5 mg/kg per day, > 5 mg/kg per day), CsA dosage at 1 year posttransplant (< or = 5 mg/kg per day, > 5 mg/kg per day), acute rejection (AR), number of AR episodes (ARE) (1, > 1), timing of AR (< or = 6 months, > 6 months), reversibility of AR (complete, partial), and infection [cytomegalovirus (CMV), non-CMV viral, bacterial]. Risk factors for the development of CR in pediatric renal transplant recipients were: AR (P < 0.0001, odds ratio 19.4), multiple ARE (> 1 vs. 1) (P < 0.0001, odds ratio 30.1), and high percentage peak PRA (> 50%) (P < 0.03, odds ratio 3.6).
慢性排斥反应（CR）是移植术后1年以上移植物丢失的最常见原因。本分析的目的是确定小儿肾移植受者发生CR的危险因素。1984年6月至1994年3月，我们中心对儿童进行了217例肾移植。免疫抑制方案包括泼尼松、硫唑嘌呤、环孢素（CsA）和预防性抗体。我们采用多变量分析，研究了以下变量对经活检证实的CR发生的影响：移植时年龄（≤5岁、＞5岁）、性别、种族、移植次数（初次移植、再次移植）、供体来源（尸体供体、活体供体）、供体年龄（＜20岁、20 - 49岁、＞49岁）、ABDR错配数（0、1 - 2、3 - 4、5 - 6）、DR错配数（0、1、2）、峰值群体反应性抗体（PRA）百分比（≤50%、＞50%）、移植时PRA百分比（≤50%、＞50%）、移植前透析、保存时间＞24小时、需要透析的急性肾小管坏死、初始CsA剂量（≤5mg/kg/天、＞5mg/kg/天）、移植后1年时的CsA剂量（≤5mg/kg/天、＞5mg/kg/天）、急性排斥反应（AR）、AR发作次数（ARE）（1次、＞1次）、AR发生时间（≤6个月、＞6个月）、AR的可逆性（完全可逆、部分可逆）以及感染[巨细胞病毒（CMV）、非CMV病毒、细菌]。小儿肾移植受者发生CR的危险因素为：AR（P＜0.0001，比值比19.4）、多次ARE（＞1次对比1次）（P＜0.0001，比值比30.1）以及高百分比峰值PRA（＞50%）（P＜0.03，比值比3.6）。
