肾移植术后IgA肾病复发危险因素分析

Risk factors for recurrence of IgA nephropathy after kidney transplantation

目的探讨肾移植术后IgA肾病复发的危险因素。方法选取2008年1月—2019年12月在郑州人民医院器官移植中心接受肾移植的149例原发病为IgA肾病的肾衰竭患者为研究对象。根据程序性肾活检结果,将肾移植后是否有IgAN复发分为复发组(40例)和未复发组(109例)。分别记录两组患者的性别、年龄、供体类型、透析时间、进展至终末期肾病(end-stage renal disease,ESRD)时间,移植病史、高血压以及糖尿病病史、术后感染病史、免疫抑制方案、人类白细胞抗原(human leucocyte antigen,HLA)错配数,统计分析术后复发的危险因素。结果复发组与未复发组患者相比,两组性别、肾移植次数、有无糖尿病、有无高血压、免疫抑制方案、术后有无感染病史、透析时间,差异无统计学意义(P>0.05)。将单因素分析中有统计学意义的因素进行Logistic分析,结果显示:供体来源、受体年龄、HLA错配数是肾移植术后IgAN复发的危险因素,差异有统计学意义(均P<0.05)。结论肾移植术后IgA肾病复发与供体来源、受体年龄、HLA错配数有关,针对以上因素采取干预措施,为临床控制IgAN的复发提供思路。

Objective To investigate the risk factors of IgA nephropathy recurrence after kidney transplantation.Methods A total of 149 kidney failure patients with primary IgA nephropathy who received kidney transplantation at the Organ Transplantation Center of Zhengzhou People's Hospital from January 2008 to December 2019 were selected as the study subjects.According to the results of the protocol kidney biopsy,the recipients were divided into the recurrent group(40 cases)and the non-recurrent group(109 cases).Gender,age,donor type,dialysis duration,progression to end-stage renal disease(ESRD),history of transplantation,history of hypertension and diabetes,history of postoperative infection,immunosuppressive regimen,HLA mismatch number,and risk factors for postoperative recurrence were recorded in the two groups.Results Compared with the non-recurrent group,there were no statistically significant differences in gender,number of kidney transplants,diabetes,hypertension,immunosuppressive regimen,postoperative infection history,dialysis time between the two groups(P>0.05).Logistic analysis showed that donor origin,recipient age and HLA mismatch were the risk factors for IgAN recurrence after renal transplantation,and the differences were statistically significant(All P<0.05).Conclusion The recurrence of IgA nephropathy after kidney transplantation was related to the source of donor,recipient age and HLA mismatch.Intervention measures should be taken according to the above factors to provide ideas for clinical control of IgAN recurrence.