Analysis Of Impact Factors For Acute Rejection After Living-donor Kidney Transplantation

Objective:To explore the impact factors for acute rejection after renal transplantation and to search for indicators to evaluate the risk of renal transplantation. Methods:Between 1980 and 2007 ,142 recipients were analyzed after living-donor kidney transplantation at the Jockey Club Centre Columns of Nepyrology in the Princess Margaret Hospital OF Hong Kong. All sorts of data which may be affect the occurrence for acute rejection after living-donor kidney transplantation were gathered , 142 recipients were followed up from 1980 to 2007 and divided into 2 groups as acute rejection or negative acute rejection according to the clinical situation of acute rejection after living-donor kidney transplantation and laboratory examination and Pathologic diagnosis (Partly recipients). The data of recipients include the age ,sex, protopathy ,dialysis types, dialysis time , transfusion frequency,immunosuppression therapy after transplant operation .The data of donor includes the age ,sex.The data of donor–recipient include the HLA–A mismatches, HLA–B mismatches, HLA-DR mismatches,the total HLA mismatches, sex pairing and relationship .Results:All sorts of factor which may be affect the occurrence for acute rejection were analyzed By Single factor analysis, the frequency of transfusion is higher in the acute rejection group than in the negtive acute rejection group(,W=687 ,P=0.00), in all sorts of immunosuppression therapy groups, the rate of occurrence for acute rejection is lower in the groups inclondes CSA than in the groups without CSA(χ~2=11.2 ,P=0.04),in three sorts of Donor–recipient relationship,the rate of occurrence for acute rejection is higher in the group whose donor is parents or children than the other groups, the rate of occurrence for acute rejection is lower in the group of sibling than the other groups(χ~2=11.2 P=0.02). The difference of the rest factors is no statistical significance,Which inclondes the recipients of the ag(eχ~2=0.89 ,P=0.87) , sex(χ~2=1.28 ,P=0.26), Native kidney disease(χ~2=7.04 ,P=0.28) ,dialysis type(χ~2=0.29 ,P=0.33), dialysis time(χ~2=11.2 ,P=0.04) ,the donor of the age(χ~2=0.89 , P=0.87) ,sex(χ~2=1.28 ,P=0.26), the donor–recipient of the HLA–A mismatches(W =2501.50,P=0.90), HLA–B mismatches(W =4700.00 ,P=0.10), HLA-DR(W =4957.5 ,P=0.88) mismatches, the total HLA mismatches(W =4834.50 ,P=0.88), sex pairing(χ~2=4.06,P=0.26). Conclusion The high frequency of transfusion would increase the potentiality of acute rejection , the higher frequency of transfusion were identified to be the impact factors of occurrence for acute rejection , the recipients whose donor is parents or children ,has much higher occurrence for acute rejection, while sibling donor has higher occurrence for acute rejection.The therapeutic regimen of immunodepressant impact the the occurrence for acute rejection.The groups with CSA have lower rate of acute rejection than the groups without CSA after renal transplantation.In all kinds of goups with CSA ,the group which combination of Prednisolone and Mycophenolate , has the lowest rate of acute rejection than others.