新疆地区亲属活体肾移植176例临床疗效分析

Living donor kidney transplantation in Xinjiang area:Analysis of 176 cases

目的:总结和分析新疆地区176例活体肾移植的临床疗效和经验。方法:回顾性研究176例活体肾移植受者的术前一般情况、术后急性排斥反应发生率、并发症、人/肾存活率。结果:1999年8月至2008年9月间在新疆本地医院共完成异体肾移植779例,活体肾移植179例(23.0%),但2006年后活体肾移植占同期移植量的69.4%。其中3例失访,资料完整者176例,包括亲属供肾175例,非亲属供肾1例(汉族)。亲属供肾包括直系亲属15例,汉族占66.7%(10/15例);三代旁系157例,少数民族占78.3%(123/157例),夫妻间3例。176例肾移植受者中,少数民族132例,男性144例。1年、3年,5年及5年以上人/肾存活率分别为94.3%/93.2%,92.0%/88.6%,92.0%/88.1%,92.0%/86.9%,急性排斥反应发生率为9.1%,肺部感染18例(10.2%),其中死亡11例(6.3%)。结论:近三年新疆地区活体肾移植呈快速增长,2006年后约占同期肾移植总量的69.4%。患者以少数民族居多(占74.4%),供者多为三代旁系亲属,而汉族患者则以直系亲属供肾为主。本组人/肾短期和中期存活率明显高于尸体肾移植,并与国内、外报道活体肾移植人/肾存活率相近,急性排斥和肺部感染发生率分别为9.1%和10.2%,死亡率为6.3%,其长期存活率有待进一步观察。

Objective：To analyse the clinical experience in patients with living donor kidney transplantation in XinJiang area. Methodology：One hundred and seventy-six patients with living donor kidney transplantion in XinJiang area from August 1999 to September 2008 were enrolled in this retrospective study. Their general conditions, the incidence of acute rejection and the way of immunosuppressive agents were investigated. Results：They were 144 male and 32 female with a mean of （37.0 ± 10. 3 ）years old. The minority nationality were 132 patients. The living donor kidney transplantation was occupied only 5% in the same period in all kidney transplantation before 2006, but after 2006, it was rising to 69.4% in all renal transplantation. The 1, 3, 5, 〉5 year patient and graft survivals were 94. 3% ,93. 2% ,92. 0% ,88. 6% and 92. 0%, 88. 1% ,92. 0% and 86. 9% , repectively. The cumulative incidence of acute cellular rejection （ACR） were 9. 1%. 18 patients sufferred from severe the lung infection, 11 patients died. Conclusion：The living donor transplantation was rapid growth in recent 3 years in XinJiang area, in which majority of patients was minorities ethnic （ 74. 4% ）, while the donors were three generationgs of family members, at the same time the donor of Han ethnic were the family people. Our data showed that HLA-mismatch rate had no very close relationship with acute rejection.