3102例次尸体肾移植临床分析

Clinical analysis of 3 102 cadaveric kidney transplantation

目的对3102例次尸体肾移植进行临床分析。方法回顾性分析1978年1月～2007年1月3102例次肾移植受者存活率、主要并发症以及死亡因素,并应用Cox模型对组织配型、免疫抑制剂方案、排斥,再次肾移植等影响因素进行多因素分析。结果(1)应用钙调神经素抑制剂前、后1、3、5、10年人/肾存活率(%)为65.6/65.6 vs 95.1/94.8,48.3/48.3 vs 88.4/85.4,30.1/30.1 vs 78.0/73.2和11.8/11.8vs 66.0/60.6;(2)超急性排斥发生率1997年前后分别为23/1120 vs 1/1 897;急性排斥反应19.5‰,慢性移植物肾病18.9%;(3)多因素分析结果表明,肾功延迟恢复、高龄受者、配型、免疫药物方案、急性排斥、外科并发症等因素可对移植肾的长期存活产生重要影响;(4)肾移植受者死亡的主要原因依次为:心脑血管系统疾病(51.4%),肝功能衰竭(23.1%),严重感染(12.9%),消化道出血(6.9%);(5)HLA供、受者配型、淋巴细胞毒和PRA可明显减少超急性排斥反应,有利于移植肾长期存活。结论尸体肾移植是救治晚期肾功能衰竭患者的有效方法。

Objectives To analyze the clinical data of 3 102 cases of renal transplantations from January,1978 to January,2007. Methods The data of 3 102 cases of cadaveric kidney transplantation were analyzed in terms of recipient and graft survival rates at 1,3,5,10 year,main complications and the factors contributing to the mortality . COX model was used to assess the significance of HLA match,rejection episodes,retransplantation and immunosuppressive regimen. Results The recipient/graft survival rates were higher after the administration of calcinurin inhibitors. The survival rates（%） before and after the administration of calcinurin inhibitors at 1,3,5,10 year was 65.6/65.6 vs 95. 1/94.8, 48.3/48.3 vs 88.4/85.4, 30. 1/30. 1 vs 78.0/73.2 and 11.8/11.8 vs 66.0/60 respectively. The incidence of hyperacute rejection rates was 2.09 % （in recent 10 years 0.05% ） and that of acute rejection and chronic rejection was 19.5% and 18.9% respectively. The results showed that delayed graft faction, aged recipient, HLA match, immunosuppressive regimen and acute rejection were very important to affect the graft survival. The leading causes of death were cardiocerebral vascular diseases, hepatic failure, serious infection, gastrointestinal bleeding and malignancy, accounting for 51.4%, 23.1%, 12.9%and 0.6% respectively. Conclusion Kidney transplantation is an effective way rescuing the patient with end stage renal disease.