不同免疫抑制方案对肾移植受者和移植肾存活的影响

The impact of immunosuppressive regimen on survival in renal transplantation

目的回顾单中心近28年肾移植受者资料,分析探讨不同免疫抑制方案对移植受者和移植肾存活的影响。方法1977年10月至2004年12月,中国人民解放军总医院总共为1804例终末期肾病患者施行了2037例肾移植手术。根据临床资料和截止2005年底的随访结果,采用Kaplan-Meier方法计算人、肾存活率,并按照Terasaki公式计算移植物的半数生存期,分析各种免疫抑制方案对移植肾和移植受者存活的影响。结果以钙调素抑制剂(CNI)为基础的免疫抑制药物治疗显著提高了移植受者和移植肾的存活率,术后1、5、10和15年受者存活率分别为95.9%、89.1%、80.5%和73.0%;移植肾存活率分别为92.7%、80.4%、64.9%和54.1%。与无CNI类药物治疗相比,受者和移植肾的同期存活率差异具有统计学意义(均P<0.0001)。在CNI为基础的三联药物治疗方案中,采用环孢素+霉酚酸酯+泼尼松方案者移植肾1、5、10年存活率高于采用环孢素+硫唑嘌呤+泼尼松方案者(1年94.3%比86.4%,5年90.9%比70.6%,10年71.3%比56.5%,均P<0.0001)。结论以CNI为基础的三联药物治疗方案显著改善了肾移植受者和移植物的存活,特别是以他克莫司为基础的或包含霉酚酸酯的治疗方案对改善肾移植受者和移植物的存活具有重要作用。

Objective To analyze the impact of immunosuppressive therapy on renal transplant survival rates based on data of kidney transplantation at a single-center. Methods Between October 1977 and December 2004, 2037 kidney transplants were performed on 1804 patients with end-stage renal disease in the Chinese PLA General Hospital. Based on the data from clinic and following-up, patient and graft survival rates were calculated by the Kaplan-Meier method and half-life and its standard error were estimated by the Terasaki＇ s formula. Results Calcineurin inhibitors （ CNIs）-based immunosuppressive regimen dramatically increased patient and graft survival rates. Patient survival rates at 1-, 5-, 10-, and 15-year were 95.9%, 89.1%, 80.5%, and 73.0%, respectively, and graft survival rates were 92.7%, 80.4%, 64.9%, and 54. 1%, respectively. Comparing with non-CNIs immunosuppressive therapy, significant differences in corresponding survival rates were found. The graft survival in triple therapy with cyclosporine/mycophenolate mofefil/prednisone was higher than that in triple therapy with cyclosporine/azathioprine/prednisone （94. 3% vs. 86. ,$% at 1-year, 90. 9% vs. 70.6% at 5-year,and 71. 3% vs. 56.5% at 10-year,P〈0.0001）. Conclusions CNIs-basedimmunosuppressive therapy significantly increased patient and graft survival, specially, with tacrolimus-based or mycophenolate mofefil-containing regimen.