抽菸會關係到腎臟移植的急性排斥


  May 31, 2005 (西雅圖) - 在美國移植外科醫學會暨美國移植協會的第6屆年會上,研究人員發表了一項新的研究結果;除了已知的風險之外,抽菸可能會關係到腎臟移植後的排斥現象。
  
  明尼蘇達州醫學教授Bertram Kasiske醫師向Medscape表示,許多研究顯示,抽菸會使得器官移植的效果不彰,如導致死亡及移植體排斥現象;本研究為第一次急性排斥的關連性研究。
  
  研究人員檢視了4,000位接受腎臟移植的患者,手術皆在明尼蘇達州的Fairview大學醫學中心及Hennepin郡醫學中心進行,期間為1984年1月至2004年7月間;研究人員對患者的抽菸習慣進行調查,約有四分之一的移植受贈者,在手術時尚有抽菸的狀況。
  
  研究人員對器官接受者進行了10年期的追蹤研究;研究的調整因子,含捐贈者為大體或活體、移植手術進行的年度、之前的移植手術、年齡、患者種族、洗腎的年數、捐贈者年齡、捐贈者性別、捐贈者死因、組織學上的明顯不相容處、異體抗體反應率、身體質量指數及延緩的移植體功能等。
  
  抽菸者,移植體失敗的相對風險增加了51%,死亡率增加45%,急性排斥率增加24%;急性排斥率在一年後高出27%,五年後高出21%。
  
  Kasiske醫師表示,生物學上的因素,目前尚不清楚,諸如免疫系統的干擾等;或者,抽菸實質上就是一個社會經濟上的風險因子,患者可能比較無法遵循其他療法的指示。
  
  Kasiske表示,抽菸並不是移植手術的禁忌,但是可以讓醫師們作為術後追蹤的參考;我會鼓勵患者戒菸,即使患者照辦,我們也不會因此而停止進行移植手術;也許這是另一個必須注意的事情,亦即一個共識,大家都應該了解,抽菸會使得排斥的風險升高,也可以藉此知道哪一位患者未服從醫療指示。
  
  紐約哥倫比亞大學的腎臟移植計畫主任David J. Cohen醫師在審視過研究報告以後向Medscape表示,有一些數據證實,抽菸對腎功能有害;如果有生物學方面的影響,我不會感到驚訝;我們仍然對抽菸者進行器官移植,但是我會告訴他們,你的治療結果會很差。
  
  這是一項獨立資助的研究;該論文的作者們未公佈研究資金的來源及狀況。

Smoking Linked to Acute Reject

By Melissa Schorr
Medscape Medical News

May 31, 2005 (Seattle) — In addition to other known risks, cigarette smoking may be associated with acute rejection following kidney transplantation, according to new research presented here at American Transplant Congress 2005: 6th Annual Joint Meeting of the American Society of Transplant Surgeons and the American Society of Transplantation.

"Several studies have shown cigarette smoking correlates to worse outcomes after transplantations, such as mortality and graft failure," Bertram Kasiske, MD, a professor of medicine at the University of Minnesota, Minneapolis-St. Paul, told Medscape. "This is the first study to find a correlation with acute rejection as well."

The researchers looked at more than 4,000 patients who received a kidney transplant at Fairview University Medical Center and Hennepin County Medical Center, Minneapolis, Minnesota, between January 1984 and July 2004. Patients were asked whether they currently were smokers. About one quarter of recipients admitted to smoking at the time of receiving their transplant.

The researchers compared outcomes of the transplant recipients up to 10 years. They adjusted the findings for factors including whether the organ was from a deceased or living donor, the year of transplantation, any prior transplants, age, ethnicity, years of prior dialysis, donor age, donor sex, donor cause of death, major histocompatibility mismatches, percentage panel reactive antibody, body mass index, and delayed graft function.

Those who smoked cigarettes had a 51% increased relative risk of graft failure, a 45% increased risk of mortality, and a 24% increased risk of acute rejection. The rate of acute rejection was 27% higher after the first year and 21% higher at five years.

It was unclear if there is a biological reason, such as interference with the immune system, or if smoking is simply a risk factor for a socioeconomic factor, such as being less likely to comply with other therapies, Dr. Kasiske said.

While smoking is not a contraindication to receiving a transplant, it may be useful information for physicians to consider when tracking patients postsurgery, Dr. Kasiske said. "I would encourage people to stop smoking, but we do not stop transplantation if they do not smoking," Dr. Kasiske said. "Maybe it is another thing to watch for, an awareness that maybe these partients are at higher risk of rejection. It is nice to know who is at risk for noncompliance."

David J. Cohen, MD, medical director of the kidney transplant program at Columbia University, New York, NY, reviewed the research and told Medscape that there are some data that smoking is bad for kidney function. "I would not be surprised if there is some biological effect," Dr. Cohen said. "We still perform transplantations on people who smoke cigarettes, but now, I can tell them, you will have a worse outcome."

The study was independently funded. The authors reported no pertinent financial disclosures.

ATC 2005: 6th Annual Joint Meeting of the American Society of Transplant Surgeons and the American Society of Transplantation: Abstract 13. Presented May 22, 2005.

Reviewed by Gary D. Vogin, MD

    
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