再次肾移植49例的回顾性分析

RETROSPECTIVE ANALYSIS OF RENAL RETRANSPLANTATION IN 49 CASES

我院自１９７８年６月至１９９５年４月共进行了１１６８次肾移植，其中再次肾移植４９例。首次肾移植失败的原因以慢性排斥为主，其次为超急性排斥反应。首次肾失功至再次肾移植时间６个月以内８例，术后肾功能恢复达６２．５％，其中２周以内再次肾移植４例，肾功能均恢复正常，半年至１年，１年至２年，２年以上再植肾功能恢复正常的分别为７１．４％、４０．０％、４１．７％。再次移植用药方案：Ｐｒｅｄ＋Ａｚａ（１６例），ＣｓＡ＋Ｐｒｅｄ＋Ａｚａ（３３例），ＣｓＡ＋Ｐｒｅｄ＋Ａｚａ＋ＡＬＧ（１３例），ＣｓＡ＋Ｐｒｅｄ＋Ａｚａ＋ＡＴＧ（５例），６个月肾存活分别为４３．８％、５４．５％、９２．３％、８０．０％。再次移植肾失功以超急性排斥为主（６４．０％），４９例中已死亡１９例，多因尿毒症性心肌病和肺部感染引起。再次移植的淋巴细胞毒性试验最好低于５％，大于１０％者效果较差。

rom June 1978 to April 1995,1168 times of renal transplant operations had been per-formed,of them,49 cases were retransplantated.The main cause of failure of the first renal transplantation were CR, the second were HAR. The duration from losing its function tn re-transplantation was less than 6 months in 8 patients,of them 62.5%resumed its function.Renal function recovered in 2 cases which lost its original function for only 2 weeks after re-transplantation. The regimen of treatment after retransplantation was Pred+Aza(16 cases)、CsA+Pred +Aza(33 cases),CsA+Pred +Aza+ALG(13 cases),CsA+Pred +Aza +ATG(5 cases).Among the 4 treatmen regimen 6 months graft survival rate was 43.8%、54.5%、92.3%and 80.0%respectively.The mein cause of retransplantation failure was HAR (64.0%).