影响致敏患者移植肾存活的危险因素分析

Analysis on the graft survival rate related factor in sensitized recipients undergoing kidney transplantation

目的探讨影响致敏患者移植肾存活的危险因素,以提高致敏患者移植肾长期存活率。方法对102例接受肾移植的致敏患者的资料进行回顾性分析,用KaplanMeier计算移植肾1、3、5年存活率,用LogRank进行单因素分析、Cox模型多因素回归分析,计算相对危险度。结果术后随访(30±2)个月,未出现超急性排斥反应,发生急性排斥反应33例,经激素及抗淋巴细胞抗体治疗后,25例逆转;16例移植肾功能丧失,其中7例死亡,死亡原因为肺部感染5例,心血管疾病2例;人/肾1、3、5年存活率分别为95%/90%、93%/85%、93%/75%;单因素及多因素分析表明,受者年龄、移植次数、HLA相配程度、PRA水平、移植后PRA升高、移植肾功能恢复正常的时间、血肌酐水平、移植肾功能恢复延迟、急性排斥反应及感染等10个因素对移植肾的存活有重要或非常重要影响。结论良好控制影响移植肾存活的危险因素,致敏患者肾移植同样能取得满意的效果。

Objective To investigate the independent prognostic factors for graft survival in sensitized recipients undergoing kidney transplantation, so as to identify the individuals at high risk of graft loss before transplantation. Methods Thirty one relative variables were analyzed by SPSS10.0 statistical software. Using Log Rank method, we retrospectively investigated the influence of these variables on short term and long term graft survival. Kaplan Meier analysis was used to estimate the 1 , 3 and 5 year graft survival rate and half life. Proportional hazards regression analysis ( Cox model) was used to assess and rank the relative risk of potential variables. Results The 1 , 3 and 5 year graft survival rate was 90 % , 85 % , and 75 % . By Log Rank analysis, factors affecting short and long term graft survival were identified as: recipient age, times of transplantation, level of PRA, appearance of the postoperative anti HLA IgG antibody, HLA mismatch, renal function, levels of blood creatinine, presence of acute rejection, delay graft function and infection. Cox model multivariate analysis showed that there were 10 factors affecting graft survival. Conclusion High quality donor kidney and minimization of the risk factors for graft survival may insure successful kidney transplantation in sensitized recipients.