- 作者：M.P. Nair ; M.R.N. Nampoory ; T. Said ; M.A. Halim ; M. Mansour ; K.V. Johny ; M. Samhan and M. Al-Mousawi
- 刊名：Transplantation Proceedings
- 出版年：2005
- 出版时间：2005
- 年：2005
- 卷：37
- 期：7
- 页码：3029-3030
- 全文大小：50 K
IntroductionEarly acute rejection episodes (ARE) have deleterious effects on graft outcomes. The incidence of ARE in the first 3 months has been reported to be <20 % . In a recent audit of ARE among 100 renal transplants, we observed the rates to be high (30 % ). We retrospectively collected details of donor type, induction therapy, immunosuppression medications, drug levels, HLA mismatches, acute tubular necrosis (ATN), and delayed graft function (DGF) to correlate with ARE and response to therapy.Results
Thirty rejection episodes occurred after a mean period of 14.3 days after transplantation. Ninety-one patients had induction treatment with either antithymocyte globulin (ATG) or interleukin 2 receptor antibodies (IL2 Rab). The drugs included cyclosporine, mycophenolate, sirolimus, azathioprine, and prednisolone in these patients. There was no significant difference in ARE among the different drug protocols (30.7 % –35.2 % ). Subjects with 4 or more HLA mismatches displayed more ARE (40.3 % ) compared with those with 3 or less (23 % ). Subjects with ATN or DGF immediately posttransplantation had a higher incidence of ARE (39.2 % ) than those without them (26.3 % ). Deceased donor recipients had a higher episode of ARE (45.1 % ) compared with live related donor recipients (25 % ). On stratifying the known risk factors for ARE, subjects with no risk factors had the least (22.2 % ) ARE compared with those with one (32.5 % ) or two (47.6 % ) risk factors. Subjects who failed to achieve adequate cyclosporine (C2) levels showed significantly higher rates of ARE (86.9 % ) than those with adequate or higher levels (8.6 % ).
Conclusion
Higher HLA mismatches, DGF, deceased donor, and failure to achieve adequate cyclosporine levels were observed to be major risk factors for the development of ARE.