肾移植后因免疫抑制剂的不良反应转换应用咪唑立宾的效果

目的 探讨肾移植术后因不良反应而将吗替麦考酚酯(MMF)或硫唑嘌呤(Aza)转换为咪唑立宾(MZR)的有效性和安全性.方法 56例肾移植受者术后发生肺部感染23例,骨髓抑制14例,肝功能损害6例,腹泻13例.所有患者均采用以钙调磷酸酶抑制剂(CNI)+MMF(或Aza)+泼尼松(Pred)的免疫抑制方案,出现不良反应时,转换应用了CNI+MZR+Pred.转换治疗后随访(33.2±17.4)个月(11～53个月),观察转换治疗后的效果和不良反应.结果 转换治疗后,23例肺部感染的患者,1例再次出现肺部感染,死于心、肺功能衰竭,其余均未再出现肺部感染;骨髓抑制的14例患者中,13例血常规恢复正常,1例未恢复;肝功能损害的6例患者经转换治疗后,肝功能均恢复正常;13例腹泻患者的症状均缓解.转换前,患者血清肌酐为(123±21.3)μmol/L,转换后,血清肌酐为(119±18.2)μmol/L,二者比较,差异无统计学意义(P＞0.05).转换治疗后,有1例(1.7%)患者发生排斥反应,9例(16.1%)出现不同程度的血尿酸升高,1例出现指(趾)关节疼痛等症状,均经对症治疗后好转.结论 在肾移植术后发生免疫抑制剂不良反应时,转换应用咪唑立宾效果良好,安全性高,为肾移植后患者的个体化免疫抑制方案的应用提供一种新的选择.

Abstract：

Objective To investigate the efficacy and safety of conversion therapy to mizoribine (MZR) for renal transplant patients who suffered MMF or Aza adverse reaction. Methods In 56 patients with adverse reactions at different time points after renal transplantation, there were 23 cases of pulmonary infection, 14 cases of bone marrow depression, 6 cases of hepatic functional lesion and 13 cases of diarrhea. The immunosuppressive protocols of these patients were changed to CNI + MZR + Pre when the adverse reaction occurred. During the follow-up period (11 to 53 months), the effect and adverse events of conversion treatment were observed. Results After conversion treatment, 1 of 23 patients with pulmonary infection was re-infected after 26 months and finally died of heart and lung function failure. In 14 patients with bone marrow depression, blood test returned to normal in 13cases. Six patients with hepatic functional lesion were administered hepatoprotection treatment and their liver function was restored without recurrence of impaired liver function. All 13 patients with diarrhea were relieved without recurrence. The serum creatinine was 123 ± 21.3 μmol/L and 119±18. 2 μmol/L before and after the conversion therapy respectively (P＞0. 05). During the follow-up period, all patients' graft function was good. The incidence of rejection was 1.7 % (1 case). Nine patients (16. 1 %) had a higher level of uric acid after conversion. One patient had finger and toe joint pain. The symptoms were relieved after symptomatic treatment. Conclusion There were high security and good effect of conversion therapy to MZR due to MMF or Aza adverse reaction. Besides, MZR conversion therapy for renal transplantation patients provided a new option for individual immunosuppression.     

肾移植后因免疫抑制剂的不良反应转换应用咪唑立宾的效果

Objective To investigate the efficacy and safety of conversion therapy to mizoribine (MZR) for renal transplant patients who suffered MMF or Aza adverse reaction. Methods In 56 patients with adverse reactions at different time points after renal transplantation, there were 23 cases of pulmonary infection, 14 cases of bone marrow depression, 6 cases of hepatic functional lesion and 13 cases of diarrhea. The immunosuppressive protocols of these patients were changed to CNI + MZR + Pre when the adverse reaction occurred. During the follow-up period (11 to 53 months), the effect and adverse events of conversion treatment were observed. Results After conversion treatment, 1 of 23 patients with pulmonary infection was re-infected after 26 months and finally died of heart and lung function failure. In 14 patients with bone marrow depression, blood test returned to normal in 13cases. Six patients with hepatic functional lesion were administered hepatoprotection treatment and their liver function was restored without recurrence of impaired liver function. All 13 patients with diarrhea were relieved without recurrence. The serum creatinine was 123 ± 21.3 μmol/L and 119±18. 2 μmol/L before and after the conversion therapy respectively (P＞0. 05). During the follow-up period, all patients' graft function was good. The incidence of rejection was 1.7 % (1 case). Nine patients (16. 1 %) had a higher level of uric acid after conversion. One patient had finger and toe joint pain. The symptoms were relieved after symptomatic treatment. Conclusion There were high security and good effect of conversion therapy to MZR due to MMF or Aza adverse reaction. Besides, MZR conversion therapy for renal transplantation patients provided a new option for individual immunosuppression.     

肾移植后因免疫抑制剂的不良反应转换应用咪唑立宾的效果

Objective To investigate the efficacy and safety of conversion therapy to mizoribine (MZR) for renal transplant patients who suffered MMF or Aza adverse reaction. Methods In 56 patients with adverse reactions at different time points after renal transplantation, there were 23 cases of pulmonary infection, 14 cases of bone marrow depression, 6 cases of hepatic functional lesion and 13 cases of diarrhea. The immunosuppressive protocols of these patients were changed to CNI + MZR + Pre when the adverse reaction occurred. During the follow-up period (11 to 53 months), the effect and adverse events of conversion treatment were observed. Results After conversion treatment, 1 of 23 patients with pulmonary infection was re-infected after 26 months and finally died of heart and lung function failure. In 14 patients with bone marrow depression, blood test returned to normal in 13cases. Six patients with hepatic functional lesion were administered hepatoprotection treatment and their liver function was restored without recurrence of impaired liver function. All 13 patients with diarrhea were relieved without recurrence. The serum creatinine was 123 ± 21.3 μmol/L and 119±18. 2 μmol/L before and after the conversion therapy respectively (P＞0. 05). During the follow-up period, all patients' graft function was good. The incidence of rejection was 1.7 % (1 case). Nine patients (16. 1 %) had a higher level of uric acid after conversion. One patient had finger and toe joint pain. The symptoms were relieved after symptomatic treatment. Conclusion There were high security and good effect of conversion therapy to MZR due to MMF or Aza adverse reaction. Besides, MZR conversion therapy for renal transplantation patients provided a new option for individual immunosuppression.     

肾移植后早期应用咪唑立宾的有效性及安全性

目的 探讨肾移植后早期应用咪唑立宾( MZR)的有效性和安全性.方法 采用前瞻性临床随机对照研究.将61例首次肾移植受者按随机数字表法分为2组:(1)MZR组:33例,应用他克莫司(Tac)+ MZR+泼尼松(Pred)预防排斥反应;(2)吗替麦考酚酯组(MMF)组:28例,应用Tac+ MMF+ Pred预防排斥反应.MZR的用法为:体重＜50 kg者为150mg/d,早餐后口服;体重≥50kg者为200 mg/d,分早、晚2次口服.MMF、Tac和Pred按常规剂量服用.2组受者均于术前2h和术后4d接受巴利昔单抗(20mg/d)诱导治疗.观察并比较2组受者术后6个月内的急性排斥反应(AR)发生率、移植肾存活率以及高尿酸血症、骨髓抑制、巨细胞病毒感染、胃肠道反应等的发生率.结果 术后6个月内,MZR组AR发生率为15.2％,MMF组AR发生率为10.7％ (P＞0.05);MZR组移植肾存活率为97.0％,MMF组移植肾存活率为89.3％(P＞0.05).MZR组和MMF组间高尿酸血症、骨髓抑制、胃肠道反应和肺部感染的发生率的差异无统计学意义(P＞0.05).其中,MZR组未发生巨细胞病毒感染,而MMF组则发生4例(36.4％),差异有统计学意义(P＜0.05).结论 在严密监测下,MZR可应用于肾移植术后早期抗排斥反应治疗.     

肾脏移植后转换咪唑立宾治疗骨髓抑制

在肾脏移植手术后的随诊当中，经常会接触到因服用免疫抑制剂而发生白细胞减少的患者，对这些患者在免疫抑制剂的使用和调整上很棘手。咪唑立宾(MZR，商品名：布累迪宁)是日本旭化成株式会社开发研制的免疫抑制剂。在日本已临床使用多年。鉴于其对骨髓无明显的抑制作用，我们在临床对因免疫抑制剂应用而发生的白细胞减少的患者，将原用的免疫抑制剂转换成MZR，在临床上取得了较好的效果。现报告如下。     

咪唑立宾在尸体肾移植术后的应用

目的 :探讨咪唑立宾 (Mzb)在尸体肾移植术后应用的效果及安全性。方法 :6 0例首次接受尸体肾移植的患者随机地分为硫唑嘌呤 (Aza)组、霉酚酸酯 (MMF)组及Mzb组 ,每组 2 0例 ,且均以环孢素A或普乐可复及泼尼松作为基础免疫抑制剂。观察术后 6个月内急性排斥反应 (AR)发生率、并发症及人 /肾存活情况。结果 :Mzb组AR发生率明显低于Aza组 (P <0 .0 5 ) ,与MMF组相近。Mzb组腹泻、全血细胞减少发生率低于MMF组 (P <0 .0 5 ) ,肝功能损害发生率低于Aza组 (P <0 .0 5 )。Aza组和MMF组中全血细胞减少者经转换为Mzb后均好转。Mzb组人 /肾均存活。结论 :Mzb同样能明显降低尸体肾移植术后AR的发生率 ,效果与MMF相似 ,而且使用安全 ,可作为Aza及MMF的替代药物     

咪唑立宾导致肾移植术后严重骨髓抑制二例报告

肾移植术后应用咪唑立宾引起严重骨髓抑制者比较少见，我院收治2例。现报告如下。     

不同剂量咪唑立宾在临床肾移植中的应用研究

目的 探讨不同剂量咪唑立宾(MZR)在临床肾移植中的应用效果及其安全性.方法 将206例首次接受肾移植的受者按手术时间排序,以奇偶数将受者列入吗替麦考酚酯(MMF)组,MZRⅠ组和MZRⅡ组.MMF组受者术后采用MMF+环孢素A(CsA)+泼尼松(Pred)的免疫抑制方案,MZRⅠ组和MZRⅡ组采用MZR+CsA+Pred的免疫抑制方案;MMF组MMF的用量为1.0g/d,MZRⅠ组和MZRⅡ组MZR的用量分别为100和200mg/d,3组间CsA和Pred的用法相同.排除失随访受者,MMF组、MZRⅠ组和MZRⅡ组分别有100、60和30例受者获得完整随访,研究终点为肾移植术后5年.比较各组受者人、肾存活率和排斥反应发生率,以及与药物相关不良反应的发生情况等.结果 MZR Ⅰ组、MZRⅡ组和MMF组受者术后总体存活率分别为88.3%(53/60)、90%(27/30)和88%(88/100),移植肾总体存活率分别为85%(51/60)、86.7%(26/30)和86%(86/100),急性排斥反应发生率分别为10%(6/60)、6.7%(2/30)和9%(9/100),3组间人、肾存活率以及急性排斥反应发生率的差异均无统计学意义(P>0.05);严重肺部感染发生率分别为3.3%(2/60)、10%(3/30)和15%(15/100),MZRⅠ组显著低于MMF组(P<0.05),而MZRⅡ组与其他两组的差异均无统计学意义(P>0.05).MZR Ⅰ组和MZRⅡ组发生严重感染者均经治疗后痊愈,而MMF组死亡11例,死亡率为73.3%(11/15).MZRⅠ组和MZRⅡ组腹泻发生率均显著低于MMF 组(P<0.05),而高尿酸血症发生率均显著高于MMF组(P<0.05).结论 咪唑立宾对预防肾移植后排斥反应是安全、有效的,受者耐受性好,对于免疫功能低下易发生感染的高危人群,以及使用MMF致顽同性腹泻者,可将含咪唑立宾的免疫抑制方案作为首选.

Abstract：

Objective To observe the efficacy and safety of different doses of mizoribine to prevent rejection after renal transplantation. Methods Sorted by time of operation and odevity, 206 primary kidney transplant recipients were divided into 3 groups, including MMF group, MZR Ⅰ group and MZR Ⅱ group. All recipients in 3 groups were administrated CsA and Pred, combined with mycophenolate mofitile (MMF) in MMF group and mizoribine (MMF) in MZR Ⅰ and Ⅱ groups.The dosage of MMF was 1. 0 g/day, while dosage of MZR in MZR Ⅰ and Ⅱ groups was 100 and 200 mg/day, respectively. There was no difference in usage of cyclosporine (CsA) and prednisone (Pred) among 3 groups. 100, 60 and 30 recipients were followed up in MMF, MZR Ⅰ and MZR Ⅱ groups respectively in 5 years. During the follow-up period of 5 years, the incidence of acute rejection, patient/graft survival and adverse effects associated with drugs in three groups were observed. Results The patient/graft survival was 88. 3 % (53/60), 85 % (51/60) in MZR Ⅰ group, 90 % (27/30),86.7 % (26/30) in MZR Ⅱ group, and 88% (88/100), 86% (86/100) in MMF group, respectively (P>0. 05). There was no significant difference in incidence of acute rejection among MZR Ⅰ (10 %, 6/60), MZR Ⅱ (6. 7 %, 2/30) and MMF groups (9 %, 9/100). The incidence of severe pulmonary infection in MZR Ⅰ group was 3. 3 % (2/60), and 10 % (3/30) in MZR Ⅱ , and the former was lower than MMF group (15 %, 15/100) significantly. There was significant difference in mortality of severe pulmonary infection between MZR Ⅰ group (0, 0/2) and MMT group (73. 3 %, 11/15). The rate of ACR in MZR Ⅱ group (10 %, 3/30) was lower significantly than MMF group (30 %, 30/100) and MZR Ⅰ group (31.7 %, 19/60). There was significant difference in the incidence of hyperuricacidemia between two MZR groups (30 %, 56. 7 %) and MMF group (10 %)(P<0. 05), while the incidence of diarrhea and myelosuppression was lower significantly in MZR Ⅰ group than in MMF group. Conclusion MZR can prevent acute rejection after kidney transplantation effectively and safely. Immunosuppressive therapy including mizoribine is the best choice especially for high risk group because of susceptibility to infection and those who suffer from tenacious diarrhea owing to the side effect.     

免疫抑制剂咪唑立宾的体外抗BK病毒作用研究

目的在体外水平上研究咪唑立宾的抗BK多瘤病毒(BKV)功能并初步分析其抑制病毒复制的阶段。方法本研究采用咪唑立宾的溶剂作为阴性对照,已知具有体外抗BKV活性的西罗莫司作为阳性对照。首先,在不同细胞系中分析咪唑立宾和西罗莫司的半致死浓度。然后,以此为依据设置药物浓度梯度处理细胞,感染BKV后在不同时间点上收集细胞上清液进行荧光定量PCR检测BKV的复制曲线,对细胞做免疫荧光检测BKV感染率。最后,用BKV单循环假病毒感染不同药物浓度处理的293FT细胞,通过流式细胞仪分析假病毒感染效率,以此判断咪唑立宾对BKV感染早期的影响。结果咪唑立宾与西罗莫司都具有体外抑制BKV感染的作用。与对照组相比,细胞免疫荧光显示BKV的感染率随着咪唑立宾浓度的增加而降低,细胞上清病毒DNA定量检测表明咪唑立宾处理组病毒复制曲线受到明显抑制。西罗莫司对BKV感染水平和复制水平的抑制作用与咪唑立宾类似,本研究中两种药物对BKV感染早期都没有显著影响。结论咪唑立宾在细胞水平上具有抗BKV活性,且抑制作用并未发生在病毒感染早期阶段。     

咪唑立宾治疗儿童紫癜性肾炎的临床观察

目的探讨咪唑立宾(mizoribine,MZR)治疗儿童紫癜性肾炎的安全性及疗效。方法纳入33例紫癜性肾炎(Ⅱb级)患儿,按其治疗方案不同分为2组:治疗组18例给予口服咪唑立宾片治疗(剂量2.5～3 mg·kg~(-1)·d~(-1)),治疗3个月后逐渐减量。对照组15例给予口服泼尼松片(1 mg·kg~(-1)·d~(-1))联合吗替麦考酚酯片(剂量20～30 mg·kg~(-1)·d~(-1)),治疗3个月后逐渐减量。两组疗程均为9～12个月,观察两组血常规、尿常规、24 h尿蛋白定量、血清白蛋白、肝肾功能及药物不良反应。结果治疗后,治疗组与对照组临床总有数率相当。两组治疗后24 h尿蛋白定量均低于治疗前,血清白蛋白水平均高于治疗前,差异有统计学意义(P0.05),血丙氨酸转氨酶、血肌酐及血尿酸变化差异无统计学意义(P0.05)。治疗组仅有2例在治疗初期出现轻微皮疹的不良反应。对照组不良反应有上呼吸道感染3例,白细胞下降3例,腹泻1例,恶心、呕吐1例。结论 MZR治疗临床表现为中度蛋白尿的紫癜性肾炎患儿,具有一定临床疗效,其疗效与泼尼松联合吗替麦考酚酯片相当,但其治疗更为简单经济、不良反应少,为儿童紫癜性肾炎的治疗提供了一种新的方案。     

肾移植术后他克莫司替换环孢素A的临床观察

目的：探讨他克莫司（FK506）的替换环孢素A（CsA)用于肾移植患者的临床效果。方法：肾移植术后对48例CsA肝中毒、10例牙龈增生、16例多毛、13例高脂血症的患者，用FK506替换CsA治疗，停用CsA 24h后开始给予FK506，初始剂量根据患者体重、肝功能损害程度及术后时间确定，服药后根据全血FK506谷值浓度调整剂量，术后半年内维持在8－10μg/L，年内6－8μg/L，1年以上4－6μg/L，观察替换治疗后患者的临床表现，严密监测肝肾功能、FK506浓度、血糖、血脂等。结果：改用FK506后，48例CsA肝中毒者中47例肝肾功能在10－48d逐渐恢复，1例无明显好转，治疗无效死亡。10例牙龈增生者均得到控制，其中6例增生的牙龈恢复正常。16例因多毛影响外观者均得到明显改善。13例高脂血症者治疗3个月后，总胆固醇水平均明显降低。结论：对应用CsA出现严重的肝功能损害、多毛、牙龈增生及高血脂的患者改用FK506是一种较好的补救方法，不增加移植肾排斥以应的发生率，且副作用少。     

Early conversion to belatacept after renal transplantation

Belatacept is a non‐nephrotoxic immunosuppressive agent, which may make it the ideal agent for patients with delayed or slow graft function on calcineurin inhibitors. There are limited data on conversion of patients to belatacept within 6 months of transplantation. Between January 2012 and December 2015, 16 patients were converted to belatacept for delayed or poor graft function (eGFR<30 mL/min/1.73 m², MDRD); three were HIV positive. Conversion protocols were analyzed in patients ≤4 months and 4‐6 months post‐transplantation. Mean serum creatinine levels after belatacept conversion were compared with preconversion levels. Patient survival was 100%, and graft survival was 88%. The mean creatinine fell from 3.9±1.82 mg/dL prebelatacept conversion to 2.1±1.1 mg/dL at 6 months and 1.9±0.47 mg/dL (median 1.8 mg/dL) at 12 months postconversion. There was no significant increased risk of rejection, infection, or malignancy. HIV parameters remained largely stable. Early conversion to belatacept in patients with DGF or slow graft function is safe and efficacious, in a single‐center nonrandomized retrospective analysis.     

Effect of atorvastatin therapy and conversion to tacrolimus on hypercholesterolemia and endothelial dysfunction after renal transplantation

BACKGROUND: Hypercholesterolemia is a frequent complication in renal transplant patients treated with cyclosporine A (CsA). Whether it is preferable to treat hypercholesterolemia with statins or to switch patients from CsA to tacrolimus (TRL) has not been investigated. METHODS: Twelve CsA-treated kidney transplant recipients with hypercholesterolemia were successively crossed over from CsA alone to: CsA plus atorvastatin; TRL alone; and TRL plus atorvastatin. Total cholesterol (C), Low density lipoprotein (LDL)-C, high density lipoprotein (HDL)-C, LDL and HDL alpha-tocopherol content, lag-time of LDL oxidation, plasma levels of oxidized LDL and the percentage of small dense LDL were assayed at the end of each treatment period. Endothelial function was assessed by high resolution ultrasound measurement of flow-mediated brachial artery vasodilatation (FMD). RESULTS: Atorvastatin therapy was more efficient in reducing total cholesterol and LDL-C levels than conversion from CsA to TRL. Combining TRL with atorvastatin further reduced LDL-C levels as compared to TRL alone, but was no more efficient than the CsA-statin combination. Neither atorvastatin therapy nor conversion to TRL significantly changed the proportion of dense LDL, lipoprotein alpha-tocopherol contents or the lag time of LDL oxidation. Addition of atorvastatin to CsA increased FMD from 4.0+/-1.8% to 6.5+/-4.0% (P<0.05 vs. CsA). Conversion from CsA to TRL caused a slight improvement in FMD (5.1+/-2.1%, P<0.05 vs. CsA). Adding atorvastatin to TRL had no detectable effect on FMD (5.5+/-2.3%, P=NS vs. TRL). CONCLUSIONS: Atorvastatin was more efficient in reducing total and LDL cholesterol levels of CsA-treated renal transplant patients than conversion to TRL and significantly improved endothelial dysfunction.     

肾移植术后发生高尿酸血症的机制

目的：探讨肾移植术后发生高尿酸血症的机制及防治策略。方法：分析480例肾移植术后患者的临床资料。结果：肾移植术后移植肾功能正常而血尿酸增高者43例(9％)，其中痛风7例，移植肾肾盂或输尿管结石3例。随访1～5年，1例痛风患者血尿酸及症状控制不理想，余血尿酸均控制在正常水平，未见并发症的发生。结论：高尿酸血症是肾移植术后较常见的问题，发生原因较多，但主要与环孢素A的作用有关；长期降尿酸及碱化尿液治疗安全、有效。     

尿毒清联合免疫抑制剂治疗肾移植术后慢性排斥反应导致慢性肾衰竭疗效观察

笔者从 1996年～ 2 0 0 0年对 2 0例肾移植术后慢性排斥反应导致慢性肾衰竭的患者采用调整免疫抑制剂 ,同时服用尿毒清的治疗方法 ,并与同期的肾移植术后慢性排斥反应导致肾衰竭的 18例患者采用免疫抑制剂同时服用大黄苏打片的治疗方法作为对照 ,现报告如下。资料与方法1　病例选择　随机选择肾移植术后慢性排斥反应有慢性肾衰竭失代偿期和肾功能衰竭期的病例 ,Ｓｃｒ均在 6 0 0μｍｏｌ/Ｌ以下 ,观察 3个月。2　慢性排斥反应诊断标准　术后 3个月以上临床上出现 :①持续性蛋白尿 ;②高血压降压效果不明显 ;③血肌酐尿素氮升高 ,排除环孢素…     

免疫抑制方案对移植肾早期各种功能状态的治疗影响

目的：分析肾移植术后早期 不同的肾功能状态下，三种免疫抑制用药方案对移植效果的影响。方法：将1196例肾移植患者根据其初始的免疫抑制用药方案分为A、B、C三组。A组：环孢素A（CsA) 硫唑嘌呤(Aza) 泥尼松（Pred);B组：CsA 霉酚酸酯（MMF）＋Pred;C组：他克莫司（FK506）＋MMF（或Aza) Pred。根据移植后早期肾功能状态，将患者分成肾功能即刻恢复正常（IGF）、缓慢恢复正常（SGF）、未恢复正常（AGF）和延迟恢复正常（DGF）四种情况。统计四种肾功能状态下，A、B、C三组患者的1年移植肾存活率、急性排斥发生率及治疗逆转率、药物副作用和相关并发症。结果：在四种不同肾功能状态下，B组或C组患者的移植肾1年存活率高于A组；B组和C组的急性排斥发生率均低于A组，急性排斥反应逆转率高于A组，但差异无显著性；B组或C组的肝功能损害、肾毒性、高血压的发生率明显低于A组。结论：在肾移植后各种肾功能状态下，B组和C组的免疫抑制方案，都可减少急性排斥反应、药物毒副作用及相关并发症的发生率，提高移植肾的存活率。     

The clinical significance of conversion of complement-dependent cytotoxic T cell crossmatch test after renal transplantation

The purpose of this study was to investigate the clinical relevance of conversion of post-transplant T cell crossmatch between kidney donor and recipient. This study comprises 892 cadaveric renal transplantations performed on 874 adult patients between August 1991 and December 1997. Recipient selection was based on a negative complement-dependent cytotoxic T cell crossmatch test with current ( ≤ 2 months old) serum. For this study, on day 0 and day 14 after transplantation, serum samples were collected for later crossmatching. On day 14 after transplantation, the crossmatch had converted to positive in 76 transplantations (8.5 %). Acute rejection occurred in 50 % of the converters and 22 % of the non-converters (P < 0.005), and graft survival was significantly poorer (P < 0.025), being 85 vs 94 % at 1 and 68 vs 83 % at 5 years, respectively. In patients with delayed graft function, 1-year graft survival was 77 % in the converters and 91 % in the non-converters (P < 0.05). Conversion of T cell crossmatch, especially in connection with delayed graft function, identifies a subgroup of patients at high risk of severe rejection and poor graft survival. Received: 18 February 1999 Received after revision: 18 August 1999 Accepted: 16 September 1999