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目的探讨活体供肾移植受者发生急性排斥反应(acute rejection,AR)的年龄因素。方法对本移植中心2006年1月-2013年12月327例行活体供肾肾移植受者随访,供者年龄≥55岁定义为老年供者,受者年龄<30岁定义为年轻受者。记录供、受者的临床基线特征;移植后第1、3、6、12、24、36、48、60个月均行随访,内容包括基本体格检查、病史、实验室检查、AR发病情况。应用单因素和Cox比例风险模型进行多因素分析,确定AR发病危险因素。结果 AR组随访时间为(35.9±13.2)个月,非AR组为(36.3±15.4)个月;肾移植术后受者前3个月内AR的发生率为7.3%(24/327)。AR组血肌酐水平、尿蛋白发生率高于同时间非AR组(P<0.05)。多因素分析显示,老年供者年轻受者是AR的独立危险因素,相对危险度(relative risk,RR)为3.67(95%CI:2.61~4.58,P=0.002)。结论接受老年供肾的年轻受者是AR的独立危险因素。
Objective To investigate the age-related acute rejection (AR) in living donor recipients. METHODS: A total of 327 living donor kidney transplant recipients from January 2006 to December 2013 in our transplant center were followed up. The age of donors ≥ 55 years old was defined as elderly donors. The recipients aged <30 years were defined as younger recipients. The clinical baseline features of donor and recipient were recorded. The follow-up was performed on the 1st, 3rd, 6th, 12th, 24th, 36th, 48th and 60th months after transplantation. The contents included basic physical examination, medical history, laboratory tests and AR. Univariate and Cox proportional hazards models were used for multivariate analysis to determine the risk factors for AR. Results The follow-up time was (35.9 ± 13.2) months in AR group and (36.3 ± 15.4) months in non-AR group. The incidence of AR was 7.3% (24/327) in the first 3 months after renal transplantation. The serum creatinine level and urinary protein in AR group were higher than those in non-AR group (P <0.05). Multivariate analysis showed that younger recipients of elderly donors were independent risk factors for AR. The relative risk (RR) was 3.67 (95% CI: 2.61-4.58, P = 0.002). Conclusion The young recipients who received the elderly donor kidney are the independent risk factors of AR.