肾移植术后存活10年以上受者的临床资料分析

Retrospective clinical analysis on recipients of more than 10 years after renal transplantation

目的对肾移植术后存活10年以上受者的临床资料以及期间出现的并发症进行分析和总结。方法回顾性分析1998年12月31日以前接受肾移植的1003例受者资料，分别统计术后存活10年以上的受者和移植肾数量，同时记录相关的存活情况、并发症发生情况以及术后初始免疫抑制方案对受者和移植肾长期存活的影响。结果截至2008年12月31日，存活10年以上的受者有629例，有功能的移植肾占存活10年以上受者的85．37％（537／629）。存活10年以上的受者中，采用以环孢素A（CsA）为基础的免疫抑制方案的占94．75％（596／629）。移植后发生的并发症有：冠心病57例（9．06％），肝脏损害32例（5．09％），肿瘤29例（4．61％），糖尿病25例（3．97％），脑血管意外16例（2．54％），严重骨髓抑制14例（2．23％），股骨头坏死7例（1．11％），下肢血栓3例（0．48％）及突发性耳聋2例（0．32％）。629例存活10年以上的受者中，已死亡49例，其中死于心脑血管意外19例（38．78％）、肿瘤10例（20．41％）、肝功能衰竭9例（18．37％）、感染4例（8．16％）、因经济紧张而放弃治疗3例（6．12％）、死因不详2例（4．08％）和意外2例（4．08％）。结论肾移植术后长期存活与移植后初期采用以CsA为主要免疫抑制剂方案有关；而非免疫因素，如心脑血管疾病的防治、早期发现肝功能异常和肿瘤是随访工作中应关注的重点。

Objective To summarize the clinical data of renal transplants survived with graft function more than 10 years and the adverse events during this period, and to discuss the main strategies for the long-term survival. Methods Survival rate of renal transplants simultaneously survived with graft function ~ 10 years and grafts was counted respectively in total 1003 renal transplant recipients at our hospital before Dec. 31, 1998 retrospectively. Their relevant survival, adverse events and initial post-operative immunosuppressive regimens were recorded simultaneously. Results As of Dec. 31, 2008, the 10-year survival rate of recipients was 62. 7% （629/1003）, and recipients with graft function accounted for 85. 37 % （537/629）. Of them, 94. 75% （596/629） recipients received cyclosporine A （CsA） -based irnmunosuppression plus other antiproliferative immunosuppressive agents. Post-transplantation adverse events included coronary heart diseases in 57 cases （9. 06 %）, liver damage in 32 cases （5. 09 %）, malignancy in 29 cases （4. 61%）, diabetic mellitus in 25 cases （3.97 %）, apoplexy in 16 cases （2. 54%）, severe bone marrow depression in 14 cases （2. 23 %）, femur head necrosis in 7 cases （1. 11%）, lower-extremity thrombosis in 3 cases （0. 48%）, sudden deafness in 2 cases （0. 32 %）. There were 690 survival patients and 49 deaths including 19 （38. 78 %） due to cardiocerebral vascular accidents, 10 （20. 41%） due to malignancy, 9 （18.37%） due to hepatic failure, 4 （8. 16 %） due to infection, 3 （6. 12%） due to treatment abandonment, 2 （4. 08 %） unknown reasons and 2 （4. 08 %） accidental deaths. Conclusion Long term survival after renal transplantation is associated with the primary medication of CsA as the main immunosuppressive regimen. The nowimmunologic factors such as the prevention and cure of cardiocerebral vascular diseases and the early finding of liver functional abnormality and tumor are the main points focused during follow-up.