尸体肾移植1210例总结分析

Experience with 1210 cases of cadaveric renal transplantation

目的总结尸体肾移植手术经验,提高肾移植长期存活率.方法回顾分析1986-2003年1210例肾移植患者取肾、手术技术、免疫抑制药应用及手术并发症发生等资料.男773例,女437例,年龄6～75岁.病因主要为慢性肾炎(1047例),1210例淋巴毒细胞试验均<10%,640例行PRA测定,340例HLA-A、B、DR配对.结果1986-1996年免疫抑制剂采用环孢素A(CsA)、泼尼松(Pred)、硫唑嘌呤(Aza),人/肾1、3、5年存活率分别为96%/95%、85%/80%、65%/64%,主要死亡原因为心脑血管疾病(99/205,48%).1997-2003年免疫抑制剂采用CsA、Pred、骁悉(MMF),人/肾1、3、5年存活率分别为96%/96%、87%/82%、66%/65%,主要死亡原因为感染(14/25,56%).结论良好的供肾和组织配型,术后合理应用免疫抑制剂,预防和及时治疗并发症是提高人/肾长期存活率的重要保证.

Objective To summarize the experience with cadaveric renal transplantation for improving the long-term survival rate of the recipients. Methods The clinical data of 1210 cases （773 men and 437 women;age range,6 -75 years） of cadaveric kidney transplantation from 1986 to 2003 were analyzed retrospectively,including the resection of the donor＇s kidneys,surgical techniques, use of immunosuppressants,and complications. The 1210 patients underwent renal transplantation for most of them （ 1047 cases） suffered from chronic glomerulonephritis. Lymphocytotoxicity test was performed in 1210 cases with all 〈 10% ; panel reactive antibody （PRA） was detected in 640 cases;and 340 cases underwent HLA-A,-B and -DR matching. Results The 1 -, 3-, 5-year patient/graft survival rates were 96%/95% , 85 %/80% , 65 % / 64% ,respectively with the immunosuppressive regimen of CsA, Aza and Pred from 1986 to 1996. The main causes of patients＇ death were rejection and cardiocerebral vascular diseases （48% ,99/205）. With the application of CsA,MMF and Pred from 1997 to 2003, the 1-,3-,5-year patient/graft survival rates were 96%/ 96% ,87%/82% ,66%/65% , respectively and infection was the main cause of death （56% , 14/25 ）. There was no significant difference in survival rates between the 2 periods. Conclusions The high quality of donors＇ kidneys and HLA matching,reasonable immunosuppressive regimen,prevention and prompt treatment of complications after transplantation may improve the patient/graft long-term survival rate.