背景:肾移植是终末期肾病的一种决定性治疗方法。它与预期寿命和生活质量的提高有关。肾移植后最常见的并发症之一是移植物排斥。据我们所知,之前没有研究发现沙特阿拉伯肾移植受者的排斥反应风险因素.因此,这项研究的目的是确定移植物排斥的具体危险因素。
方法:在沙特阿拉伯的四个移植中心进行了一项多中心病例对照研究。所有在2015年01月01日至2021年31月12日期间接受肾移植的成年患者均接受筛选。根据两年内活检证实的排斥反应的发生,将纳入的患者分为两组(病例和对照组)。主要结果是确定移植前两年内排斥反应的危险因素。根据患者年龄,使用1:4的比例进行精确匹配,性别,移植年。
结果:在1320名接受筛查的肾移植受者中,包括816名患者。2年排斥反应的总发生率为13.9%。在双变量分析中,已故捐赠者身份,存在供体特异性抗体(DSA),术中低血压,血清氯化物水平,铜绿假单胞菌,念珠菌,两年内的任何感染都与两年内排斥反应的风险增加有关。然而,在逻辑回归分析中,DSA被确定为两年排斥的显著风险(校正OR2.68;95%CI,1.10,6.49,p=0.03)。同时,移植前1周组反应性抗体(PRA)的存在和较高的血清氯化物水平与较低的排斥反应几率相关(分别为校正OR0.12;95%CI,0.03,0.53,p=0.005和校正OR0.93;95%CI,0.86,0.98,p=0.02).此外,血液感染,移植后2年内感染铜绿假单胞菌或BK病毒后,2年排斥的几率较高(调整后OR分别为3.10;95%CI,1.48,6.48,p=0.003,调整后OR为3.23;95%CI,0.87,11.97,p=0.08;调整后OR为2.76;95%CI,0.89,8.48,p=0.07).
结论:我们的研究结果强调需要适当预防和管理肾移植后的感染,以避免更严重的问题,比如拒绝,这可能会显著增加同种异体移植失败的可能性甚至死亡。需要进行更大样本量的进一步研究,以研究移植前血清氯化物水平和术中低血压对排斥反应风险的影响。
BACKGROUND: Kidney transplantation is a definitive treatment for end-stage renal disease. It is associated with improved life expectancy and quality of life. One of the most common complications following kidney transplantation is graft rejection. To our knowledge, no previous study has identified rejection risk factors in kidney transplant recipients in Saudi Arabia. Therefore, this study aimed to determine the specific risk factors of graft rejection.
METHODS: A multicenter
case-control study was conducted at four transplant centers in Saudi Arabia. All adult patients who underwent a renal transplant between January 1, 2015 and December 31, 2021 were screened for eligibility. Included patients were categorized into two groups (cases and control) based on the occurrence of biopsy-proven rejection within 2 years. The primary outcome was to determine the risk factors for rejection within the 2 years of transplant. Exact matching was utilized using a 1:4 ratio based on patients\' age, gender, and transplant year.
RESULTS: Out of 1,320 screened renal transplant recipients, 816 patients were included. The overall prevalence of 2-year rejection was 13.9%. In bivariate analysis, deceased donor status, the presence of donor-specific antibody (DSA), intraoperative hypotension,
Pseudomonas aeruginosa, Candida, and any infection within 2 years were linked with an increased risk of 2-year rejection. However, in the logistic regression analysis, the presence of DSA was identified as a significant risk for 2-year rejection (adjusted OR: 2.68; 95% CI: 1.10, 6.49, p = 0.03). Furthermore, blood infection, infected with
Pseudomonas aeruginosa or BK virus within 2 years of transplant, were associated with higher odds of 2-year rejection (adjusted OR: 3.10; 95% CI: 1.48, 6.48, p = 0.003, adjusted OR: 3.23; 95% CI: 0.87, 11.97, p = 0.08 and adjusted OR: 2.76; 95% CI: 0.89, 8.48, p = 0.07, respectively).
CONCLUSIONS: Our findings emphasize the need for appropriate prevention and management of infections following kidney transplantation to avoid more serious problems, such as rejection, which could significantly raise the likelihood of allograft failure and probably death. Further studies with larger sample sizes are needed to investigate the impact of serum chloride levels prior to transplant and intraoperative hypotension on the risk of graft rejection and failure.