Renal allograft survival following acute rejection correlates with blood pressure levels and histopathology

被引:37
作者
Cosio, FG
Pelletier, RP
Sedmak, DD
Pesavento, TE
Henry, ML
Ferguson, RM
机构
[1] Ohio State Univ, Div Nephrol, Dept Internal Med, Columbus, OH 43210 USA
[2] Ohio State Univ, Dept Surg, Columbus, OH 43210 USA
[3] Ohio State Univ, Dept Pathol, Columbus, OH 43210 USA
关键词
graft survival; transplantation; renal allograft; hypertension;
D O I
10.1046/j.1523-1755.1999.00752.x
中图分类号
R5 [内科学]; R69 [泌尿科学(泌尿生殖系疾病)];
学科分类号
1002 ; 100201 ;
摘要
Background Acute rejection (AR) is a strong predictor of renal graft survival but the negative impact of AR on survival is variable, suggesting that other factors modulate this relationship. In this study, we examined the variables that correlate with graft survival after AR, particularly the impact of blood pressure (BP), graft function, and histopathology. Methods. The study population included patients with no AR (N = 942) and patients with one (N = 407) or two (N = 156) AR during the first year post-transplant. Patients were adults who were recipients of living related (LRD, N = 410) or cadaveric grafts (CAD, N = 1095) and who were transplanted in a single institution and followed for 5.8 +/- 4 years. Results. Compared with patients without AR, those with AR were significantly younger, had more human lymphocyte antigen mismatches, and included more CAD recipients. Graft survival was analyzed beyond six-months post-transplant. In patients with AR. reduced survival correlated (multivariate) with (a) younger recipients (P = 0.01), (b) AR occurring later during the first-year post-transplant (P = 0.0006), (c) elevated serum creatinine (Cr) before (P = 0.05), at the time (P = 0.0001) of, or after AR (P = 0.0004), and (d) average BP levels after AR [systolic BP (P = 0.003 logistic, P < 0.0001 by Cox), diastolic BP (P = 0.007), mean arterial pressure (P < 0.0001)]. This latter correlation was independent of graft function and recipient race. Thus, post-AR BP levels correlated with graft survival in patients with post-AR creatinine less than or equal to 2 mg/dl (N = 408, P = 0.0009), in Caucasian recipients (P = 0.001), and in African American recipients (P = 0.01). In contrast, there was no significant correlation between BP levels and graft survival in patients without AR. AR histopathology, analyzed in patients with one AR episode, correlated with graft survival only the first six months after AR but not thereafter. Conclusions. Graft survival after AR can be predicted independently by graft function and BP levels after the event. Patients with elevated BP post-AR have poor graft survival even if they have excellent graft function.
引用
收藏
页码:1912 / 1919
页数:8
相关论文
共 17 条
[1]   RACIAL-DIFFERENCES IN RENAL-ALLOGRAFT SURVIVAL - THE ROLE OF SYSTEMIC HYPERTENSION [J].
COSIO, FG ;
DILLON, JJ ;
FALKENHAIN, ME ;
TESI, RJ ;
HENRY, ML ;
ELKHAMMAS, EA ;
DAVIES, EA ;
BUMGARDNER, GL ;
FERGUSON, RM .
KIDNEY INTERNATIONAL, 1995, 47 (04) :1136-1141
[2]   Impact of acute rejection and early allograft function on renal allograft survival [J].
Cosio, FG ;
Pelletier, RP ;
Falkenhain, ME ;
Henry, ML ;
Elkhammas, EA ;
Davies, EA ;
Bumgardner, GL ;
Ferguson, RM .
TRANSPLANTATION, 1997, 63 (11) :1611-1615
[3]   Clinical implications of the diagnosis of renal allograft infarction by percutaneous biopsy [J].
Cosio, FG ;
Pesavento, TE ;
Sedmak, DD ;
Farhan, N ;
Pelletier, RP ;
Henry, ML ;
Elkhammas, EA ;
Bumgardner, GL ;
Ferguson, RM .
TRANSPLANTATION, 1998, 66 (04) :467-471
[4]   Correlation between Banff classification, acute renal rejection scores and reversal of rejection [J].
Gaber, LW ;
Moore, LW ;
Alloway, RR ;
Flax, SD ;
ShokouhAmiri, MH ;
Schroder, T ;
Gaber, AO .
KIDNEY INTERNATIONAL, 1996, 49 (02) :481-487
[5]   Utility of standardized histological classification in the management of acute rejection [J].
Gaber, LW ;
Moore, LW ;
Gaber, AO ;
First, MR ;
Guttmann, RD ;
Pouletty, P ;
Schroeder, TJ ;
Soulillou, JP .
TRANSPLANTATION, 1998, 65 (03) :376-380
[6]  
Gjertson D W, 1992, Clin Transpl, P299
[7]   REMISSION OF NEPHROTIC RANGE PROTEINURIA IN TYPE-I DIABETES [J].
HEBERT, LA ;
BAIN, RP ;
VERME, D ;
CATTRAN, D ;
WHITTIER, FC ;
TOLCHIN, N ;
ROHDE, RD ;
LEWIS, EJ .
KIDNEY INTERNATIONAL, 1994, 46 (06) :1688-1693
[8]  
Keown P, 1996, TRANSPLANTATION, V61, P1029
[9]   THE EFFECTS OF DIETARY-PROTEIN RESTRICTION AND BLOOD-PRESSURE CONTROL ON THE PROGRESSION OF CHRONIC RENAL-DISEASE [J].
KLAHR, S ;
LEVEY, AS ;
BECK, GJ ;
CAGGIULA, AW ;
HUNSICKER, L ;
KUSEK, JW ;
STRIKER, G ;
BUCKALEW, V ;
BURKART, J ;
FURBERG, C ;
FELTS, J ;
MOORE, M ;
ROCCO, H ;
DOLECEK, T ;
WARREN, S ;
BEARDEN, B ;
STARKEY, C ;
HARVEY, J ;
POOLE, D ;
DAHLQUIST, S ;
DOROSHENKO, L ;
BRADHAM, K ;
WEST, D ;
AGOSTINO, J ;
COLE, L ;
BAKER, B ;
HAIRSTON, K ;
BURGOYNE, S ;
LAZARUS, J ;
STEINMAN, T ;
SEIFTER, J ;
DESMOND, M ;
FIORENZO, M ;
CHIAVACCI, A ;
METALIDES, T ;
KORZECRAMIREZ, D ;
GOULD, S ;
PICKETT, V ;
PORUSH, J ;
FAUBERT, P ;
SPITALEWITZ, S ;
FAUBERT, J ;
ZIMMER, G ;
SAUM, D ;
BLOCK, M ;
WOEL, J ;
ROSE, M ;
DENNIS, V ;
SCHWAB, S ;
MINDA, S .
NEW ENGLAND JOURNAL OF MEDICINE, 1994, 330 (13) :877-884
[10]   Long-term renal allograft survival - Prognostic implication of the timing of acute rejection episodes [J].
Leggat, JE ;
Ojo, AO ;
Leichtman, AB ;
Port, FK ;
Wolfe, RA ;
Turenne, MN ;
Held, PJ .
TRANSPLANTATION, 1997, 63 (09) :1268-1272