LONG-TERM DETERIORATION OF KIDNEY ALLOGRAFT FUNCTION (DEKAF)

同种异体移植肾功能的长期恶化 (DEKAF)

• 批准号: 7604882
• 负责人: Lawrence G. Hunsicker
• 金额: $ 0.22万
• 依托单位: UNIVERSITY OF IOWA
• 依托单位国家: 美国
• 财政年份: 2007
• 资助国家: 美国
• 起止时间: 2007-03-01 至 2007-09-16
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/7604882
• 关键词: Acute; Antibodies; Chronic; Clinical; Computer Retrieval of Information on Scientific Projects Database; Deterioration; Dialysis procedure; End stage renal failure; Failure; Functional disorder; Funding; Goals; Graft Survival; Grant; HLA Antigens; Immunosuppression; Incidence; Inflammation; Institution; Intervention; Kidney Transplantation; Laboratories; Organ; Outcome; Pathologic; Physical Dialysis; Probability; Protocols documentation; Rate; Research; Research Personnel; Resources; Source; Therapeutic immunosuppression; Time; Today; United States National Institutes of Health; Waiting Lists; base; cohort; improved; kidney allograft; prospective

This subproject is one of many research subprojects utilizing the resources provided by a Center grant funded by NIH/NCRR. The subproject and investigator (PI) may have received primary funding from another NIH source, and thus could be represented in other CRISP entries. The institution listed is for the Center, which is not necessarily the institution for the investigator. The two major problems in clinical kidney transplantation (ktx) today are late graft loss (LGL) and the shortage of organs. In fact, these problems are interrelated - ktx failure is currently the 3rd leading cause of end stage renal disease (ESRD) in the U.S. and recipients returning to the waiting list contribute to the organ shortage. For the past decade it was hoped that decreasing the incidence of acute rejection (AR) would reduce LGL. In fact, the use of modern immunosuppression has decreased AR rates during the last year post-ktx to <10% at many centers; this has been associated with improvement in long-term function (the slope of the GFR) has also improved, perhaps related to superior control of rejection with newer protocols. Despite these advances, LGL continues to be a problem: almost 4,500 ktx recipients returned to dialysis in 2003, most of them late (>1 year post-tx). Furthermore, improvements in graft survival have plateaued. Thus, we have improved AR rates and early outcomes but LGL remains a problem; our previous conceptualization provides an inadequate basis for effective intervention. The long-term goal of this study is to understand and reduce long-term ktx deterioration. The specific aims of the study are to 1) determine, in a previously ktx cross-sectional cohort, whether clinical, laboratory, or pathologic studies at the time of initial graft dysfunction define clinico-pathologic entitites; 2) determine, in a prospective cohort, whether clinical, laboratory, and pathologic studies at the time of initial graft dysfunction define different entitites; and 3) determine whether markers of fibrogenic activity and/or inflammation, the presence of anti-human leukocyte antigen antibodies, or other clinical correlates can define the probability of progression and the rate of progression of chronic graft dysfunction.

该副本是利用众多研究子项目之一 由NIH/NCRR资助的中心赠款提供的资源。子弹和 调查员（PI）可能已经从其他NIH来源获得了主要资金， 因此可以在其他清晰的条目中代表。列出的机构是 对于中心，这不一定是调查员的机构。 如今，临床肾移植（KTX）的两个主要问题是晚期移植物损失（LGL）和器官短缺。 实际上，这些问题是相互关联的-KTX失败是美国目前的第三主要原因，在美国和返回候补名单的接收者伴随着器官短缺。 在过去的十年中，希望降低急性排斥（AR）的发生率会减少LGL。 实际上，在KTX后，在许多中心，现代免疫抑制的使用已降低到<10％。这与长期功能的改善（GFR的斜率）的改善也有所改善，这可能与较新协议对排斥的控制相关。 尽管有这些进展，但LGL仍然是一个问题：2003年将近4,500 ktx的接收者返回透析，其中大多数是晚期（TX之后> 1年）。 此外，移植生存的改善已经平稳。 因此，我们提高了AR率和早期结果，但LGL仍然是一个问题。我们以前的概念化为有效干预提供了不足的基础。 这项研究的长期目标是了解和减少长期的KTX恶化。 该研究的具体目的是1）确定在先前的KTX横截面队列中，无论是在初始移植功能障碍时是否临床，实验室或病理研究定义了临床病理学效果； 2）确定在前瞻性队列中，在初始移植功能障碍时是否临床，实验室和病理研究定义了不同的权利； 3）确定纤维化活性和/或炎症的标志物，抗人白细胞抗原抗体的存在或其他临床相关性是否可以定义进展的概率以及慢性移植功能障碍的进展率。