儿童肾移植术后急性排斥反应相关影响因素的单中心队列研究  

Factors associated with acute rejection after pediatric kidney transplantation:a single-center cohort study

作　　者：郭志良 萨如拉 朱兰[1] 赵光远 赵大强 郭晖[1] 刘斌[1] 蒋继贫[1] 陈知水[1] 陈刚[1] Guo Zhiliang;Sa Rula;Zhu Lan;Zhao Guangyuan;Zhao Daqiang;Guo Hui;Liu Bin;Jiang Jipin;Chen Zhishui;Chen Gang(Institute of Organ Transplantation,Affiliated Tongji Hospital,Tongji Medical College,Huazhong University of Science&Technology Key Laboratory of Organ Transplantation,Ministry of Education Ministry of Health Chinese Academy of Medical Sciences,Wuhan 430030,China)

机构地区：[1]华中科技大学同济医学院附属同济医院器官移植研究所,器官移植教育部重点实验室,国家卫生健康委员会器官移植重点实验室,中国医学科学院器官移植重点实验室,武汉430030

出　　处：《中华器官移植杂志》2023年第2期68-74,共7页Chinese Journal of Organ Transplantation

基　　金：华中科技大学同济医学院附属同济医院临床研究领航项目(2019CR108)。

摘　　要：目的总结单中心儿童肾移植后急性排斥反应(acute rejection,AR)发生情况和对移植物及受者存活的影响及AR发生的相关因素。方法回顾性分析华中科技大学同济医学院附属同济医院器官移植研究所2014年5月1日至2022年5月20日行儿童肾移植155例的临床资料,排除12例术后1周内发生移植肾血栓受者后,最终纳入143例。根据是否发生AR分为AR组(29例)和无AR组(114例),比较两组供受者的基本资料和移植肾/受者存活率,采用逻辑回归分析AR的相关影响因素。结果143例儿童肾移植中,130例(90.9%)来自尸体供肾,其中儿童供肾120例(83.9%)。27例(18.9%)为婴幼儿受者(年龄<3岁)。中位随访时间为33.0(14.0,58.6)个月,29例(20.3%)出现34次AR。AR组的再次移植、儿童供肾和兔抗人胸腺细胞免疫球蛋白(rabbit anti-human thymocyte globulin,rATG)诱导比率分别为27.6%(8/29)、96.5%(28/29)和79.3%(23/29),均显著高于无AR组的7.9%(9/114)、80.7%(92/114)和36.0%(41/114),组间比较,差异均有统计学意义(P=0.007,P=0.046,P<0.001)。多因素回归分析显示,巴利昔单抗诱导比rATG诱导显著降低AR风险(比值比为0.13,95%CI:0.04~0.43,P<0.001)。AR事件发生的中位时间为术后1.3个月,23次(67.6%)为穿刺活检证实。抗AR治疗后52.9%(18/34)获得治愈,38.3%(13/34)移植肾功能好转,8.8%(3/34)因AR不可逆导致移植肾功能丧失。AR组1年、3年的移植肾存活率分别为75.3%和68.4%,显著低于无AR组的95.2%和90.4%,组间比较,差异均有统计学意义(P=0.01),而两组间受者的1年、3年存活率差异无统计学意义。结论儿童肾移植术后AR发生率较高且对移植肾存活有一定影响,巴利昔单抗诱导可有效降低AR风险。Objective To summarize the incidence of acute rejection(AR)after pediatric kidney transplantation(KT)at a single center and examine its impact on graft/patient survival and risk factors for AR.Methods This is a retrospective cohort study including pediatric recipients who underwent kidney transplantation in past 8 years.After excluding recipients of graft thrombosis within a week post-transplant and lost to follow-ups,a total of 143 cases were ultimately recruited and assigned into two groups of AR(n=29)and non-AR(n=114).Basic profiles of both donors and recipients and graft/patient survival rate were compared between two groups.Relative risk factors for AR episodes were also examined by Logistic regression.Results Renal grafts for 130/143 cases(90.9%)were harvested from deceased donors and 120(83.9%)cases from children.Twenty-seven transplants(18.9%)were performed in infants and young recipients aged<3 years.During a median follow-up of 33 months,34 AR episodes occurred in 29(20.3%)patients.Rate of re-transplantation(27.6%vs.7.9%),pediatric donor(96.5%vs.80.7%)and rabbit anti-human thymocyte globulin(rATG)induction(79.3%vs.36%)were significantly higher in AR group than non-AR group(P=0.007,P=0.046,P<0.001).Multivariate regression analysis indicated that basiliximab induction caused a significant reduction in the risk of AR incidence as compared with rATG induction(odds ratio 0.13,95%confidence interval 0.04-0.43,P<0.001).The median time of AR incidence was 1.3 months post-transplantation and 23 episodes(67.6%)were confirmed by biopsy.After anti-rejection treatment,52.9%(n=18)of the cases achieved a full recovery and 38.3%(n=13)had improved graft function.However,3 cases(8.8%)developed irreversible graft failure.The 1/3-year graft survival rates were significantly lower in AR group than those in non-AR group(75.3%vs.95.2%,68.4%vs.90.4%,P=0.01),and there was no significant difference in 1-and 3-year patient survival rates between two groups.Conclusions The incidence of AR is relatively high in pediatric renal tran

关 键 词：儿童 肾移植 急性排斥反应 免疫诱导治疗 

分 类 号：R726.9[医药卫生—儿科]