肾移植术后6个月血清肌酐水平对移植肾长期存活的影响

Post transplant renal function in half a year as a predictor of long term graft survival in kidney transplant recipients

目的探讨肾移植术后半年肾功能对移植肾长期存活的影响。方法回顾性分析自1992年4月至2001年3月在本中心进行首次单纯尸体肾移植病例794例的临床资料。根据术后6个月时间点血清肌酐(Scr)水平,分为肾功能异常组(Scr>133μmol/L)与肾功能正常组(Scr≤133μmol/L)。通过Kaplan-Meier方法分别计算包括急性排斥(AR)、延迟复功(DGF)和不包括AR、DGF时两组患者带功和排除带功死亡时移植肾短期和长期存活率。结果两组在受体移植时年龄、淋巴毒、冷/热缺血时间及免疫抑制剂方案无显著性差异;而男女性别比例、受体体重、随访时间、术后6个月内AR和DGF发生率、术后6个月或12个月环孢素A(CsA)剂量、随访期间及Scr水平等差异有显著性意义。肾功能异常组与正常组相比有较高的AR和DGF的发生率,但不管是否存在AR和DGF,肾功能异常组带功和排除带功死亡时移植肾的长期存活均明显低于肾功能正常组。结论术后6个月Scr水平影响移植肾的长期存活。

Objective To explore the influence of renal function in half a year on long term graft survival. Methods The clinical data of 794 patients who received their first cadaveric transplants between April 1992 and March 2001 were analyzed retrospectively. According to the serum creatinine(Scr) at 6 months after transplant operation, hyper creatinine group defined as Scr more 133 μmol/L, while patients whose Scr less than or eqnal to 133 μmol/L belonged to normal creatinnine group. The influence of demographic characteristics (recipients′age, gender), transplant variables (CDC, follow up time, cold/warm ischemia time), and post tansplant variables (immunosuppressive agents for the prevention of acute rejection, graft survivals, follow up serum creatinine) were analyzed. Kaplan Meier assay was used to calculate the allograft survival. Results There were no differences among recipients′age, CDC, cold/warm ischemia time, immunosuppression between two groups. Gender, follow up time, acute rejection in first 6 months, delayed graft function(DGF), dosage of CsA at 6 and 12 months post transplant, serum creatinine at 6 months, were significantly different. If patients with AR and with DGF were excluded, there was a significant difference of long term allograft survival between two groups as well. Conclusions Scr level at six months after transplantation predicts long term renal function and renal graft survival. Early interventional studies should be conducted to improve allograft survival.