41例再次肾移植的临床分析

Renal retransplantation in 41 cases

目的：总结再次肾移植的临床经验，提高移植肾的长期存活率。方法：回顾分析1999年1月～2005年12月41例再次肾移植的临床资料，统计移植后受者1、3、5年的移植肾存活率及影响存活率的因素。结果：再次移植后1、3、5年移植肾存活率分别为85．4％、76．2％、65．8％；再次移植前切除原移植肾患者1、3、5年移植肾存活率分别为88．9％、74．7％、62．2％，术后急性排斥反应的发生率为33．3％；再次移植前未切除原移植肾患者1、3、5年移植肾存活率分别为82．6％、77．1％、68．5％，术后急性排斥反应的发生率为30．4％，二者存活率及急性排斥反应发生率差异均无统计学意义。PRA阳性患者术后急性排斥反应的发生率高于PRA阴性患者，应用抗体诱导治疗的患者术后急性排斥反应的发生率低于未诱导治疗的患者。结论：再次移植前切除原移植肾不能提高再次移植的远期存活率，采用良好的肌A配型及抗体诱导治疗有利于移植肾的存活。

Objective：To summarize the long-term surval rate of the recipients receiving renal retransplantation. Methods：The clinical data of 41 cases of renal retransplantation between January 1999 and December 2005 were analyzed retrospectively. Of them, 18 underwent allograft nephrectomy （group 1 ） and 23 did not （group 2）. The graft survival rate at 1, 3, and 5 years, the factors contributiving to the mortality and factors affecting the graft survival were observed. Results： The 1-, 3-, and 5-year graft survival rates were 85.4%, 76.2%, and 65.8%, respectively, and those in group A and B were 88.9% vs 82.6% （P 〉 0.05） ; 74.7% vs 77.1% （ P 〉 0.05）, and 62.2% vs 68.5% （P 〉 0.05）, respectively. Acute rejection （AR） rates were not significantly different between groups A （33.3%） and B （30.4%） （P 〉 0.05）. Incidence of AR was higher in patients with positive PRA, however, antibody-inducing therapy could lower the incidence of AR. Conclusions： Graft nephrectomy before retransplantation can not lengthen the long-term survival, and high quality of HLA matching and antibody-inducing therapy may improve the long-term survival rate of graft.