신이식 환자에서 만성거부반응의 위험인자

Abstract

Chronic rejection is a major barrier to long-term renal allograft survival. Cyclosporine, though effective at reducing the graft loss due to acute rejection, has had little impact on the incidence of chronic rejection. Between December 1984 and April 1995, 221 patients received a primary living donor kidney transplantation. In our study, 154 patients(70%) never had an episode of acute rejection, 22% had only one, and 8% had more the one. The incidence of chronic rejection was 12% in those who had no acute rejection, 39% in those with one or more rejection episode. The 5-year graft survival was 28% for recipients with biopsy-proven chronic rejection versus 83% for without(P <0.001). In an univariate analysis, donor age, serum creatinine level at 1 and 2 year post transplantation, cyclosporine dosage at year( < 4 mg/kg vs >= 4 mg/kg) were significant risk factors for chronic rejection. In a logistic regression of multivariate analysis, we found that risk factors for chronic rejection were acute rejection episode(P < 0.0001) and donor age(P<0.01).