再次肾移植21例

Renal retransplantation in 21 cases

回顾性分析2000-01/2007-01收治的再次肾移植患者21例的临床资料,统计移植后1,3,5年人/肾存活率,分析影响存活率的因素。首次移植肾失功的原因包括排斥反应17例,输尿管梗阻1例,血栓形成3例(肾动脉、肾静脉、肾内静脉各1例)。再次移植后1,3,5年人/肾存活率分别76%/62%,76%/53%和59%/42%。使用和未用抗体诱导患者1年肾存活率分别为83%和33%,群体反应性抗体阴性和阳性患者1年肾存活率分别67%和0,差异均有显著性意义(P<0.05)。而患者年龄是否超过40岁及距离首次肾移植的时间是否超过6个月均与1年肾生存率无关(P>0.05)。21例患者中发生排斥反应11例次,发生率52%。其中超急性排斥反应3例,发生率14%,3例群体反应性抗体均为阳性,分别为10%,15%和22%,立即切除移植肾继续血液透析治疗;急性排斥反应8例次,发生率38%,经过激素冲击或OKT3治疗后均逆转;移植肾功能延迟恢复6例,发生率29%,其中4例经血液透析后肾功恢复。受者年龄和距离首次移植时间与移植肾存活率不存在明确关系,采用抗体诱导治疗和选择群体反应性抗体阴性受者有利于移植肾的存活,移植后用药应选择肝毒性小的免疫抑制剂,当首次移植肾完全失功时为避免出现并发症及减轻患者经济负担应切除失功肾。

The clinical data of 21 cases of renal retransplantation between January 2000 and January 2007 were analyzed retrospectively.The graft survival rate at 1,3 and 5 years,the factors contributive to the mortality and factors affecting the graft survival were observed.The main causes of failure of the first renal transplantation were as follows：there were 17 cases rejection,1 case obstruction of urethra,3 cases thrombosis（The located at renal artery,renal veins and internal kidney veins）.Survival rates at 1,3,5 year of the patient/graft of retransplantation group were 76/62%,76%/53% and 59%/42% respectively.Survival rates at 1 year of the graft of patients who applied and not applied antibody induction were 83% and 33% respectively.Survival rates at 1 year of the graft of patients whose panel reaction antibody（PRA）was negative and positive were 67% and 0% respectively.Both of them had significant difference（P〈0.05）.Whether the patients were older than 40 years or whether the time exceeded 6 months after renal transplantation was not related to the 1 year survival rates.There were 11 cases（52%）caught rejection and 6 cases who caught delayed graft function（DGF）.Of the total rejection patients,there were 3 cases（14.29%）hyperacute rejection（PRA were 10%,15% and 22%,respectively）.Their transplantation renals were resected and undertook hematodialysis treatment.8 cases（38%）acute rejection,who were reversed by hormone or OKT3.6 cases（29%）delayed renal graft function and 4 of them were cured after hemodialysis.There is no definite association between the long-term survival rate of graft and recipients＇ age or the time after the first transplantation.To use the antibody inductive treatment and select PRA negative recipient would profit the long-term survival of graft.The immunodepressant which has less hepatotoxicity should be selected after renal retransplantation.The failure kidney should be resected in order to avoid complication and relive economical burden of patients when they are useless.