肾脏移植15年回顾

Fifteen year's experience with cadaveric kidney transplantation

自１９７７年１０月至１９９３年４月，我们共作尸体肾移植３９８例４４４例次。迄今人存活３２０例（８０．４％），死亡７８例（１９．６％）；肾脏存活３０８例（６９．４％），丢失１３６例（３０．６％）；最长带肾存活已达１５年６个月。总的移植效果统计表明，术后１、５、１０和１５年的人存活率分别为８８．２％、７１．９％、５９．８％和５２．３％；同期肾存活率分别为８１．５％、５２．６％、３６．８％和３０．７％。在不同的免疫抑制药物治疗组中，以环孢素Ａ（ＣｓＡ）＋雷公藤多甙（ＧＴＷ）＋泼尼松（Ｐｒｅｄ）组的移植效果最好，其术后１、２、３年的人存活率均为９８．８％，肾存活率分别为９６．１％、９０．４％和７５．３％，显著高于ＣｓＡ＋硫唑嘌呤（Ａｚａ）＋Ｐｒｅｄ组和Ａｚａ＋Ｐｒｅｄ组。肾移植术后患者的生活质量大大提高，３０８例带肾存活的患者中９７％健康状况良好，移植肾功能正常，９０．９％的患者已恢复全日或半日工作。术后１４例年轻患者结婚，６例已生育。应用Ｃｏｘ模型，对本组资料中可能影响移植肾存活的１７个变量进行多因素回归分析显示：免疫抑制药物治疗、冷缺血与热缺血时间、肾功能正常时间等４个变量是影响移植肾存活的重要因素，而移植前输?

A series of 444 consecutive cadaveric kidney in 398 patients were performed between October 1977and April 1993.Up to now,320(80.4%)patients are alive and 78(19.6%)patients already dead,with 308(69.4%)functioning grafts and l36(30.6%)lost grafts.Of the 308 patients with renal graft,97% have rehabilitated with a normal graft function and 90.9%returned to full-time or half-timework.The overall 1-,5-,10-,and 15-year patient and graft survival rates were 88.2% and 81.5%,71.9%and 52.6%,59.8%and 36.8%,and 52.3%and 30.7%,respectively,In the recent years,patient and graft survivals have significantly increased to 92.0%and 87.0%at 1-year,80.0% and 64.0% at 5-year,respectively.The triple therapy including a lower dose of CsA dramatically improved transplant survival.In GTW +CsA + Pred group,one year patient and graft survival rates reached 98.8% and 96.1%,being significantly higher than that in CsA +Aza +Pred and Aza+Pred groups.Multivariate analysis of 17 variables by Cox regression model revealed that four factors(immunosuppressive regimen,cold and warm ischemia times,and delayed graft function)significantly impacted on graft survival.But the effect of pretransplant blood transfusions on graft survival did not show a;significant difference between transfused and nontransfused patients.The fact that graft loss in this series was predominently caused by rejection(52.9%)suggests that histocompatibility matching is a very important factor for allograft survival.