胰肾联合移植术后发生急性排斥反应的危险因素及生存分析  

Risk factors and survival analysis of acute rejection in recipients after simultaneous pancreas-kidney transplantation

作　　者：陈荣鑫[1] 刘路浩[1] 方佳丽[1] 李光辉[1] 徐璐[1] 张鹏 熊韫祎 吴佳林[1] 马俊杰[1] 陈正[1] Chen Rongxin;Liu Luhao;Fang Jiali;Li Guanghui;Xu Lu;Zhang Peng;Xiong Yunyi;Wu Jialing;Ma Junjie;Chen Zheng(Department of Organ Transplantation,Second Affiliated Hospital,Guangzhou Medical University,Guangzhou 510260,China)

机构地区：[1]广州医科大学附属第二医院器官移植科,广州510260

出　　处：《中华器官移植杂志》2023年第12期735-742,共8页Chinese Journal of Organ Transplantation

基　　金：广东省医学科研基金(A2022250);广州市泌尿疾病学重点学科(2021-2023);广州市临床重大科技项目(2019ZD12);广州医科大学临床重点专科(010004001)。

摘　　要：目的总结单中心胰肾联合移植(simultaneous pancreas-kidney transplantation,SPK)术后发生移植胰腺和移植肾急性排斥反应(acute rejection,AR)的临床特征及其危险因素,探讨AR对移植胰腺、肾及受者存活的影响。方法回顾性分析2016年9月至2022年7月在广州医科大学附属第二医院器官移植中心行SPK 218例受者的临床资料。根据移植术后是否发生AR,分为AR组(53例)和无AR组(165例)。比较两组供受者的临床资料,采用二元logistic回归分析AR的危险因素,Kaplan-Meier法绘制生存曲线比较两组受者、移植胰腺和移植肾存活率。结果218例受者中,53例(24.3%)出现AR,包括31例(14.2%)移植胰AR(其中5例出现2次AR),15例(6.9%)移植肾AR(1例出现2次AR),11例(5.0%)移植胰和移植肾AR(2例出现2次AR)。AR组和无AR组他克莫司血药浓度分别为(5.8±1.2)μg/L和(6.3±1.6)μg/L,他克莫司血药浓度未达标者分别有36例(67.9%)和78例(47.3%),组间比较,差异有统计学意义(P=0.040和0.009)。随访期间,AR组与无AR组肺炎与泌尿系统感染发生率[43.4%(23/53)比27.3%(45/165)和39.6%(21/53)比18.8%(31/165)]比较,差异有统计学意义(P=0.028和0.002)。多因素回归分析结果显示,他克莫司血药浓度未达标是SPK受者移植物发生AR的独立危险因素(OR=2.254,95%CI:1.167~4.353,P=0.016)。AR组和无AR组受者术后1年和5年存活率(98.1%比93.9%和92.1%比92.4%)比较,差异无统计学意义(P=0.233和0.806)。AR组和无AR组移植胰1年和5年存活率(94.3%比100%和89.4%比98.6%)比较,差异有统计学意义(P=0.003和0.004)。AR组和无AR组移植肾1年和5年存活率(92.5%比100%和90.2%比100%)比较,差异有统计学意义(P值均<0.001)。结论SPK术后移植胰、移植肾AR发生率较高,AR组肺炎与泌尿系统感染发生率相对也较高。他克莫司血药浓度未达标是发生AR的独立危险因素。AR的发生对移植胰、肾的存活有一定影响。Objective To summarize the clinical characteristics and risk factors of acute rejection(AR)of transplanted pancreas and kidney after simultaneous pancreas-kidney transplantation(SPK)and explore the effects of AR on the survival of transplanted pancreas,kidney and recipients.Methods From September 2016 to July 2022,the relevant clinical data were retrospectively reviewed for 218 recipients undergoing SPK.According to whether or not AR occurred after SPK,they were assigned into two groups of AR(n=53)and non-AR(n=165).The relevant clinical data were compared for two groups of donors and recipients and the risk factors of AR analyzed by binary Logistic regression.Kaplan-Meier method was employed for comparing the survival rates of recipients/transplanted pancreas and kidneys in two groups.Results A total of 53 cases(24.3%)developed ARs of transplanted pancreas(n=31,14.2%)(5 of 2 ARs),transplanted kidney(n=15,6.9%)(1 of 2 ARs)and transplanted pancreas&kidney AR(n=11,5.0%)(2 of 2 ARs).Tacrolimus blood levels in AR and non-AR groups were(5.8±1.2)and(6.3±1.6)μg/L and failed to attain targets in 36(67.9%)and 78(47.3%)cases.During follow-ups,the incidence of pneumonia and urinary tract infections in AR group versus non-AR group were[43.4%(23/53)vs.27.3%(45/165)and 39.6%(21/53)vs.18.8%(31/165)]and the differences were statistically significant(P=0.028&0.002).The results of multifactorial regression analysis revealed that sub-optimal blood level of tacrolimus was an independent risk factor for an occurrence of AR in grafts of SPK recipients(OR=2.254,95%CI:1.167-4.353,P=0.016).Comparisons of 1/5-year postoperative survival rates between recipients in AR and no-AR group(98.1%vs.93.9%and 92.1%vs.92.4%)indicated that the differences were not statistically significant(P=0.233&0.806).Through comparing 1/5-year survival rates of transplanted pancreas in AR and non-AR groups(94.3%vs.100%,89.4%vs.98.6%),the differences were statistically significant(P=0.003&0.004).And 1/5-year survival rates of transplanted kidneys in AR and non-A

关 键 词：胰肾联合移植 急性排斥反应 危险因素 预后 

分 类 号：R699.2[医药卫生—泌尿科学] R657.5[医药卫生—外科学]