Reduction in acute rejections decreases chronic rejection graft failure in children: A report of the North American Pediatric Renal Transplant Cooperative Study (NAPRTCS)

被引:59
作者
Tejani, A [1 ]
Ho, PL
Emmett, L
Stablein, DM
机构
[1] New York Med Coll, Dept Pediat & Surg, Valhalla, NY 10595 USA
[2] EMMES Corp, Potomac, MD USA
关键词
chronic rejection; cyclosporine therapy; pediatric patterns;
D O I
10.1034/j.1600-6143.2002.020205.x
中图分类号
R61 [外科手术学];
学科分类号
摘要
Chronic rejection accounted for 32% of all graft losses in 7123 pediatric transplants. In a previous study acute, multiple acute and late acute rejections were risk factors for the development of chronic rejection. We postulated that the recent decrease in acute rejections would translate into a lower risk for chronic rejection among patients with recent transplants. We reviewed our data on patients transplanted from 1995 to 2000, and using multivariate analysis and a proportional hazards model developed risk factors for patients whose grafts had failed due to chronic rejection. A late initial rejection increased the risk of chronic rejection graft failure 3.6-fold (p <0.001), while a second rejection resulted in further increase of 4.2-fold (p <0.001). Recipients who received less than 5 mg/kg of cyclosporine at 30 days post-transplant had a relative risk (RR) of 1.9 (p =0.02). Patients transplanted from 1995 to 2000 had a significantly lower risk (RR=0.54, p <0.001) of graft failure from chronic rejection than those who received their transplants earlier (1987-94). Since we were able to demonstrate that there is a decreased risk of chronic rejection graft failure in our study cohort, we would conclude that the goal of future transplants should be to minimize acute rejections.
引用
收藏
页码:142 / 147
页数:6
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