193例老年肾移植的临床分析

Clinical study of 193 renal transplant recipients over 60 years old

目的:分析高龄患者术前合并疾病、术后并发症特点,观察对肾移植效果的影响。方法:对我院1990年1月至2004年12月间的193例60岁以上肾移植受者的临床资料进行回顾性分析,总结术前合并疾病、术后并发症的情况及对肾移植预后的影响。结果:术前合并疾病以消化系统(30例,15.5%)和心血管系统(25例,13.0%)为主。术后发生急性排斥33例(17.1%)、感染56例(29.0%)。随访4～95个月,患者1年、3年存活率分别为88%、84%,移植肾1年、3年存活率分别为86%、80%。主要死亡原因为肺部感染和心衰。结论:高龄终末期肾病患者术前合并疾病较多,以消化系统和心血管疾病为主。预防心血管疾病和重症感染,以减少带肾死亡,有助于提高肾移植效果。

Objective：To analyze the characteristics of preoperative concomitant diseases and postoperative complications in renal transplant recipients over 60 years old, as well as their effects to transplantation outcome. Methodology ：The clinical data of these patients who underwent renal transplantation from January 1990 to December 2004 was retrospectively studied. The characteristics of preoperative concomitant diseases, postoperative complications and the outcome of renal transplantation was analyzed. Results ：The main concomitant diseases were of digestive system （ n = 30, 15.5% ） and cardiovascular system （n =25, 13.0% ）. The main complications were acute rejection （n = 33, 17. 1% ） and infection （ n = 56, 29.0% ）. During the follow-up of 4 to 95 months, the patient survival rates at 1 and 3 years were 88% and 84% respectively, and the graft survival rates were 86% and 80% respectively. 22 patients died mostly of severe pulmonary infection and heart failure. Conclusion：The patients over 60 years old have more preoperative concomitant diseases, which are derived mainly from digestive system and cardiovascular system. The prevention of cardiovascular diseases and severe infections is a good way to decrease ＂death with graft function＂ and to improve transplant outcome.