活体肾脏移植供者年龄和性别对术后早期发生急性排斥反应的影响

目的 探讨供肾因素导致活体肾脏移植受者早期发生急性排斥反应的危险因素.方法 采用前瞻性定群研究对2004年4月至2007年11月的117例首次活体肾脏移植受者进行随访,记录急性排斥反应.按供者年龄分为两组,应用Kaplan-Meier乘积极限法计算急性排斥反应累积发病率;并以对数秩检验比较两组差异.应用COX比例风险模型分析受者术后早期发生急性排斥反应的独立危险因素.结果 随访中位数时间为16个月(术后3～44个月).供者年龄≥50岁组的受者在移植术后2周、6周急性排斥反应发生率分别为13.0%和19.5%;高于供者年龄<50岁组(2.8%和8.5%),差异有统计学意义(P=0.010).COX比例风险模型分析显示,女性供者(RR=2.731,95%CI:1.018～7.326)、老年供肾(RR:1.054,95%CI:1.004～1.107)是受者术后早期急性排斥反应发生率的独立危险因素(均P＜0.05).结论 活体肾脏移植中,老年供者选择应更加严格;在老年供肾摘取和移植过程中应尽最避免肾脏损伤;接受老年或女性供肾的受者,术后早期免疫抑制药物应足量应用.

Effects of donor age and gender on early acute rejection episode in living related donor kidney transplantation

Objective To identify the risk factors of acute rejection events after living related donor renal transplant.Methods Renal transplantation was performed on 117 patients, 85 males and 32 females, aged 9-57, with the kidneys from 117 donors, 63 males and 54 females, aged(47±6) (20-65).The cumulative incidence of acute rejection events was respectively evaluated by Kaplan-Meier product-limit method and log-rank test.Cox's proportional hazards model was used to determine the risk factors for acute rejection events.Results Follow-up was conducted for 16 (3 -44) months.The acute rejection rotes 2 and 6 weeks after transplantation of the group with the donor aged ≥50 were 13.0% and 19.5% respectively, both significantly higher than those of the group with the donor aged <50 (2.8% and 8.5% respectively, P =0.010).The risk of being female for acute rejection was 2.731 times as that of being male (95% CI:1.018 -7.326 ,P =0.046), and the risk of donor aged ≥50 for acute rejection was 1.054 times as that of the donors aged <50 (95%(CI:1.004 - 1.107,P =0.020).Conclusion The requirement for selecting elder living kidney donor should be stiff.Injury to the kidney should be avoided when the kidney of an eider donor is removed and transplanted.Early administration of sufficient immunosuppressive agents is necessary to the recipients of the kidney from an old or female living donor.