影响致敏患者移植肾存活的危险因素分析

摘要/Abstract

摘要： 目的探讨影响致敏患者移植肾存活的危险因素,识别引起移植物失功的高危患者,以提高致敏患者移植肾长期存活率。方法选择102例行肾移植术的致敏患者进行回顾性研究,用Kaplan-Meier计算1、3、5年移植肾存活率,用log-rank进行单因素分析和Cox模型多因素回归分析,计算相对危险度。结果 102例致敏患者随访期间移植肾失功16例,其中死亡7例,术后1年内死亡5例,术后2及3年带肾死亡各1例。死亡原因肺部感染5例、心血管疾病2例,失访3例。1、3、5年人存活率为95%、93%和93%,1、3、5年肾存活率为90%、85%和75%,移植肾半生存期为8.9年。单因素及多因素分析表明受者年龄、移植次数、PRA水平、术后PRA水平升高、HLA相配程度、移植肾功能恢复正常时间、移植肾功能延迟恢复、急性排斥反应、血肌酐水平、感染等10个因素对移植肾的存活产生重要或非常重要影响。结论通过控制影响移植肾存活的危险因素,致敏患者移植肾存活同样能取得满意效果。

Abstract: Objective To investigate the independent prognostic factors for graft survival in sensitized recipients undergoing kidney transplantation, so as to identify the individuals at high risk of graft loss before transplantation. Methods A retro-spective investigation was conducted in 102 sensitized kidney transplant recipients and 31 relative variables were analyzed with SPSS10.0 software. Using log-rank method, the influence of these variables on short-and long-term graft survivals was evaluated, and Kaplan-Meier analysis was performed to estimate the 1-, 3-and 5-year graft survival rates and half-life. Proportional hazards regression analysis (Cox model) was used to assess the relative risks of the potential variables. Results In the recipients with a mean half-life of 8.9 years, the 1-, 3-and 5-year graft survival rates were 90%, 85%, and 75%, respectively. By log-rank analysis, the factors affecting short-and long-term graft survivals were identified, namely the recipient age, times of transplantation, levels of panel reactive antibody and the post-operative anti-HLA-IgG antibody, HLA mismatch, renal function, time needing for graft function recovery, presence of acute rejection, delay of graft function recovery and infection, which affected the graft survival demonstrated by Cox model multivariate analysis. Conclusion High-quality donor kidney and minimization of the risk factors for graft survival may insure successful kidney transplantation in sensitized recipients.

中图分类号:

R699.2

黄先恩¹, 夏穗生¹, 李留洋², 范礼佩², 李民², 赵明². 影响致敏患者移植肾存活的危险因素分析[J]. 南方医科大学学报, 2004, 24(02): 121-125,132.

HUANG Xian-en¹, XIA Sui-sheng¹, LI Liu-yang², FAN Li-pei², LI Min², ZHAO Ming². Risk factors for graft survival in sensitized recipients of kidney transplantation[J]. Journal of Southern Medical University, 2004, 24(02): 121-125,132.

参考文献

[1] Hariharan S, Johnson CP, Bresnahan BA, et al. Improved graft survival after renal transplantation in the Unite States. 1988 to 1996[J]. N Engl J Med, 2000, 342(9): 605-12.
[2] 肖序仁,敖建华,李炎唐,等.肾移植1 180例次生存分析[J].中华外科杂志,2000,38(8):578-81.Xiao XR, AO JH, LI YT, et al. Survival analysis after kidney transplantation in 1 180 cadaveric grafting[J]. Chin J Surg, 2000, 38(8):578-81.
[3] 齐隽,闵志廉,朱有华,等.肾移植术后存活影响因素分析[J].中华外科杂志,2002,40(4):241-5.Qi J, Min ZL, Zhu YH, et al. Cadaver renal transplantation and multivariate analysis for graft survival: a clinical review of 2 016 cases[J].Chin J Surg,2002,40(4):241-5.
[4] 李留洋,胡丽娟,李民,等.肾移植后人类白细胞抗原抗体检测的临床意义[J].中华检验医学杂志,2002,25(1):324.Li LY, Hu LJ, Li M, et al. Detection of anti-HLA antibodies and its clinical implication after kidney transplantation[J]. Chin J Lab Med, 2002, 25(1): 32-4.
[5] El-Awar N, Terasaki P, Lazda V, et al. Almost all patients who are waiting for regraft of a kidney transplantation have anti-HLA antibodies[J]. Transplant Proc, 2002, 34(7): 2531-2.
[6] Crespo M, Delmonico FL, Saidman SL, et al. Acute humoral rejection in kidney transplantation[J]. Graft, 2000, 3(1): 12-7.
[7] Halloran PF, Wadgymar A, Ritchie S, et al. The significance of anti-class Ⅰ antibody response. Clinical and pathologic features of anti-class Ⅰ mediated rejection[J]. Transplantation, 1990, 49 (1):85-91.
[8] Halloran PF, Schlaut J, Solez K, et al. The significance of anti-class Ⅰ antibody response Ⅱ. Clinical and pathologic features of renal transplants with anti-class I-like antibody[J]. Transplantation, 1992,53(2): 550-5.
[9] Abe M, Kawai T, Futatsuyama K, et al. Postoperative production of anti-donor antibody and chronic rejection in renal transplantation[J]. Transplantation, 1997, 63(11): 1616-9.
[10] Sayegh MH. Why do we reject a graft? Role of indirect allo-recognition in graft rejection[J]. Kidney Int, 1999, 56(5): 1967-79.
[11] Susal C, Opelz G. Kidney graft failure and presensitization against HLA class Ⅰ and class Ⅱ antigens[J]. Transplantation, 2002, 73(8):1269-73
[12] Bryan CF, Shield CF, Pierce GE, et al. Successful cadaveric renal transplantation of patients highly sensitized to HLA class Ⅰ antigens[J]. Clin Transplant, 2000, 14(1): 79-84.
[13] 李留洋,岳良升,赵明.高致敏肾移植供受者的HLA配型研究[J].中华泌尿外科杂志,2000,21(12):721-3.Li LY, Yue LS, Zhao M. A study of HLA matching in donors and highly sensitized recipients of renal transplantation[J]. Chin J Urol,2000, 21(12): 721-3.
[14] Wheeler DC, Steiger J. Evolution and etiology of cardiovascular diseases in renal transplant recipients[J]. Transplantation, 2000, 70(Suppl): S41-5.
[15] West M, Sutherland DE, Matas AJ. Kidney transplant recipients who die with functioning grafts: serum creatinine level and cause of death[J]. Transplantation, 1996, 62(7): 1029-30.