黄远航, 范立明, 邓素雄, 等. 移植肾肾炎复发与新发患者的存活情况及影响因素分析[J]. 器官移植, 2019, 10(1): 67-73. DOI: 10.3969/j.issn.1674-7445.2019.01.010
引用本文: 黄远航, 范立明, 邓素雄, 等. 移植肾肾炎复发与新发患者的存活情况及影响因素分析[J]. 器官移植, 2019, 10(1): 67-73. DOI: 10.3969/j.issn.1674-7445.2019.01.010
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Huang Yuanhang, Fan Liming, Deng Suxiong, et al. Analysis of survival and influencing factors of patients with recurrent and de novo nephritis of renal allograft[J]. ORGAN TRANSPLANTATION, 2019, 10(1): 67-73. DOI: 10.3969/j.issn.1674-7445.2019.01.010
Citation: Huang Yuanhang, Fan Liming, Deng Suxiong, et al. Analysis of survival and influencing factors of patients with recurrent and de novo nephritis of renal allograft[J]. ORGAN TRANSPLANTATION, 2019, 10(1): 67-73. DOI: 10.3969/j.issn.1674-7445.2019.01.010
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移植肾肾炎复发与新发患者的存活情况及影响因素分析

Analysis of survival and influencing factors of patients with recurrent and de novo nephritis of renal allograft

    摘要
  • 摘要:
      目的  分析移植肾肾炎复发与新发患者的存活情况及影响因素。
      方法  回顾性分析接受移植肾穿刺病理活组织检查（活检）的95例患者的临床资料。根据活检结果分为复发组（28例）、新发组（33例）、无肾炎组（34例）。统计并分析3组患者术后1、3、5年生存情况并计算相应生存率，采用Kaplan-Meier生存曲线分析患者5年生存情况。对复发组和新发组患者的临床资料进行单因素分析，再采用Logistic回归分析移植肾肾炎复发和新发患者预后的影响因素。
      结果  3组患者术后1年生存率比较，差异无统计学意义（均为P > 0.05）。新发组及无肾炎组患者术后3年生存率分别为97%和100%，均显著高于复发组的86%（均为P < 0.05）。新发组及无肾炎组患者术后5年生存率分别为82%和91%，均显著高于复发组的61%（均为P < 0.05）。Logisitic回归分析结果显示，移植肾肾炎复发患者的生存率与肾移植次数、冷缺血时间（≥12 h）、免疫抑制方案、术后血清肌酐（Scr）恢复时间（≥14 d）、术后1个月内情况（急性肾小管坏死、超急性排斥反应、急性排斥反应）及肾炎类型（IgA肾病、局灶节段性肾小球硬化、溶血性尿毒综合征）相关（均为P < 0.05）；移植肾肾炎新发患者的生存率与冷缺血时间（≥12 h）、免疫抑制方案、术后Scr恢复时间（≥14 d）及术后1个月内情况（急性肾小管坏死、超急性排斥反应、急性排斥反应）相关（均为P < 0.05）。
      结论  移植肾肾炎复发患者的生存率低于新发患者与无肾炎者，冷缺血时间、免疫抑制方案、术后Scr恢复时间及术后1个月内情况是影响移植肾肾炎复发与新发患者预后的重要因素。

     

    Abstract:
      Objective  To analyze the survival and influencing factors of patients with recurrent and de novo nephritis of the renal allograft.
      Methods  Clinical data of 95 patients undergoing pathological puncture (biopsy) of the renal allograft were retrospectively analyzed. According to the biopsy results, all recipients were assigned into the recurrent group (n=28), de novo group(n=33) and non-nephritis group (n=34). The 1-, 3- and 5-year survival was statistically analyzed and the survival rates were calculated in three groups. Kaplan-Meier survival curve was adopted to analyze the 5-year survival. Clinical data of patients with recurrent and de novo nephritis were analyzed by univariate analysis. Logistic regression analysis was utilized to analyze the influencing factors of clinical prognosis of patients with recurrent and de novo nephritis.
      Results  The 1-year survival rate did not significantly differ among three groups (all P > 0.05). The 3-year survival rates in the de novo group and non-nephritis group were 97% and 100%, significantly higher than 86% in the recurrent group (both P < 0.05). The 5-year survival rates in the de novo group and non-nephritis group were 82% and 91%, considerably higher than 61% in the recurrent group (both P < 0.05). Logistic regression analysis demonstrated that the survival rate of patients with recurrent renal nephritis was significantly correlated with the times of renal transplantation, cold ischemia time (≥12 h), immunosuppressive regime, recovery time of postoperative serum creatinine (Scr) (≥14 d), complications at postoperative 1 month (acute renal tubular necrosis, ultra-acute rejection and acute rejection) and type of nephritis (IgA nephropathy, focal segmental glomerular sclerosis and hemolytic-uremic syndrome) (all P < 0.05). In patients with de novo nephritis, the survival rate was significantly associated with cold ischemia time (≥12 h), immunosuppressive regime, recovery time of postoperative Scr (≥14 d) and complications at postoperative 1 month (acute renal tubular necrosis, ultra-acute rejection and acute rejection) (all P < 0.05).
      Conclusions  The survival rate of patients with recurrent renal nephritis is lower than those in their counterparts with de novo nephritis and without nephritis. Cold ischemia time, immunosuppressive regime, recovery time of postoperative Scr and complications at postoperative 1 month are pivotal influencing factors of the clinical prognosis of patients with recurrent and de novo nephritis of the renal allograft.

     

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