50岁以上肾移植的临床分析

Kidney transplantation in patients over 50

自１９８９年１月～１９９５年１２月共施行同种异体尸肾移植术５５６例次，其中５０岁以上患者１８２例（３２７％），对这些患者的临床资料进行比较分析。结果显示：５０岁以上组１、３、５年的人／肾存活率分别为８３４％／７９３％、７７１％／７１１％和５４５％／４５５％，与４９岁以下组比较差异无显著性（Ｐ＞００５），急性排斥发生率并不比４９岁以下组高，并发症发生率尤其是感染发生率及致死率均高于４９岁以下组（Ｐ＜００５）。本资料说明，年龄不是肾移植的主要影响因素，感染和心血管并发症是主要的死亡原因和影响长期存活的因素。适应证的选择和术前充分透析，术后合理应用免疫抑制剂，定期复查及心、肝、肺功能的监护，是提高高龄肾移植患者长期存活的主要因素。

From Jan.1989 to Dec.1995,182 patients out of 556 underwent kidney transplantation was above 50 years of age.The 1 year,3 year and 5 year patient/graft survival rate of these elderly patients were 83.4%/79.3%,77.1%/71.1%and 54.5%/45.5% respectively with no significant difference to the younger patients and so was the incidence of acute rejection episodes.However,post operative incidence of infection was higher.Infection and cardiovascular complication were the main causes of morbidity and mortality in elderly patients.It was pointed out that kidney transplantation is not contraindicated in elderly patients.The indication,preoperative care,immuno suppressive therapy and the postoperative care for elderly patients were discussed.