2520例次肾移植的临床分析

Clinical analysis of 2520 renal transplantations in one center

目的对肾移植资料进行总结，以提高人、肾长期存活率。方法回顾性分析2520例次肾移植资料。2520例次中．首次移植2490例次，二次移植30例次。术后采用环孢素A、硫唑嘌呤（或霉酚酸酯）和糖皮质激素预防排斥反应．2000年以后的患者接受减量方案，部分患者采用他克莫司、霉酚酸酯和泼尼松预防排斥反应。分析导致移植肾功能丧失和患者死亡的危险因素。结果截至2009年6月30日，2520例次。肾移植中有135例次失访．随访率为94．6％。术后6个月内急性排斥反应总的发生率为18．0％；群体反应性抗体阳性者术后6个月内急性排斥反应发生率为25．7％，明显高于阴性者的17．0％（P〈0．05）；HLA抗原错配数在4个以下者术后6个月内急性排斥反应发生率为16．9％，明显低于HIA抗原错配数≥4个者（23．7％，P〈0．01）；2520例次的人／肾（包括死亡时移植肾功能正常者）1、3、5、10年存活率分别为94．5％／96．0％、91．6％／93．1％、88．5％／90．1％和81．7％／80．6％。多因素Cox回归分析提示，急性排斥反应及免疫抑制方案是影响移植肾功能的独立危险因素；不同的免疫抑制方案、肺部感染、心脑血管意外、肝功能衰竭及肿瘤是影响患者预后的独立危险因素。结论优化免疫抑制方案、严格的HLA配型以及术后并发症的有效防治是提高人、肾长期存活率的关键。

Objective To evaluate the effects of different strategies on short- and long-term clinical outcomes of renal transplantation in Chinese subjects. Methods 2520 renal transplantations were retrospectively evaluated, including 2490 first renal transplantations and 30 second renal transplantations. Triple-immunosuppressant including cyclosporine A , azathioprine or mycophenolate mofetil （MMF） and prednisone （Pred） was adopted. Patients receiving kidney transplantation were given low dose immunosuppressants since 2000. Immunosuppressants including tacrolimus, MMF and Pred were adopted in some patients since 2000. Risk factors leading to graft loss and patients＇ death were analyzed. Results Until the cut date of June 30,2009,135 patients lost follow-up,and the follow- up rate was 94. 6 %. Incidence of acute （within 6 months post-transplantation） rejection was 18 % among 2520 patients. Incidence of acute rejection （within 6 months post-transp｜antation） was 25.7 % in panel reactive antibody （PRA） positive patients,significantly higher than 17. 0 % in PRA negative patients （P〈0.05）. Incidence of acute rejection within 6 months post-transplantation was 16. 9 % in HLA mismatches 〈4 patients, significantly lower than 23. 7 % in HLA ≥4 patients （P〈0.01）. Total patient/death censored graft 1-, 3 , 5 and 10 year survivals were 94. 5 %/96. 0 %, 91.6 %/ 93. 1 %,88. 5 %/90. 1% and 81.7 %/80. 6 %, respectively. Acute rejection and irnmunosuppressant regimen were independent risks for allograft loss. Immunosuppressant regiment, pulmonary infection, cardic-brain-vessel accident, hepatic failure and tumor were independent risks for patients＇ death. Conclusion Renal allograft and patient survival appeared to be improved by optimal immunosuppressant regimen, strict HLA match and efficient post-transplant complication prophylaxis.