Objective: To evaluate pre-and early post-transplantation risk factors for acute rejection(AR) in kidney recipients. Methods: This subgroup analysis of a multi-center registry study was conducted on living-donor kidney transplant recipients in China with 10 years of follow-up. This study analyzed 1 255 recipients including 921 males(73.4%) and with a mean age of (33±10)years. Data from patients were first analyzed with univariate analysis and then multivariate analysis was used for finding out the potential risk factors of AR. Results: A total of 106(8.4%) patients were suspected with AR after kidney transplantation, while 1 149 patients were considered as non-AR. Multivariable analysis demonstrated a significant influence of recipient age and cold ischemia time(CIT) on the occurrence of AR(OR: 0.956, 95% CI: 0.923-0.990; OR: 1.006, 95% CI: 1.002-1.011, respectively). The frequency of severe infection was significantly higher in the AR group than non-AR group(38.7% vs 10.8%; P<0.000 1). The occurrence of new-onset diabetes mellitus and tumors was similar in the two groups. Conclusions: Recipient age and CIT are risk factors for AR after living-donor kidney transplantation. Reducing CIT and intensive management of younger recipient could benefit kidney transplant patients.
目的 评估中国活体肾移植受者移植前及移植后早期各项因素与急性排斥反应(AR)发生的相关性。 方法 这是一个多中心回顾性注册研究的亚组分析，纳入1995年1月至2008年12月间在中国接受活体肾移植的1 255例受者，其中男921例(73.4%)，平均年龄(33±10)岁。对于患者发生AR的情况进行了单因素分析，同时应用多因素Logistic回归对可能影响AR发生的风险因素进行分析。 结果 共106例(8.4%)受者发生肾移植术后AR，而其余1 149例患者无AR发生。多变量分析显示，受者年龄和冷缺血时间(CIT)对发生AR有显著的影响(OR：0.956，95% CI：0.923～0.990；OR：1.006，95% CI：1.002～1.011)。AR受者严重感染的发生率较无AR受者显著升高(38.7%比10.8%，P<0.000 1)，而二者具有类似的新发糖尿病和肿瘤的发生率。 结论 受者年龄较轻与较长的CIT是活体肾移植术后AR的风险因素。减少CIT和对年轻受者加强重症监护管理有益于肾移植患者的术后恢复。.