活体肾移植急性排斥反应的临床特点及转归

Clinical characteristics and prognosis of acute rejection in living renal transplantation

背景:临床实践中发现活体肾移植急性排斥反应并不少见,耐激素导致的排斥反应屡有发生,且临床表现不典型,易漏诊、误诊,严重者导致移植失败,影响人/肾长期存活率。目的:探讨活体肾移植急性排斥反应临床特点及转归。方法:通过回顾性分析比较2005-02/2008-09活体肾移植192例和尸体肾移植168例急性排斥反应的临床表现、并发症及治疗转归,对活体肾移植急性排斥反应特点进行分析。结果与结论:活体肾移植和尸体肾移植急性排斥反应及耐激素排斥反应发生率分别为9.8%,46.2%和22.8%,57.8%,差异有显著性意义(P<0.05)。活体肾移植急性排斥反应时发热,移植肾区疼痛、血尿、尿少等症状及感染、肾周血肿等并发症少于尸体肾移植。活体肾移植19例急性排斥反应经强化治疗全部逆转,而尸体肾移植38例急性排斥反应,35例逆转,2例破裂切除,1例肾静脉血栓形成。临床分析提示,活体肾移植较尸体肾移植急性排斥反应发生率低,耐激素急性排斥反应少,临床表现轻,易逆转,预后好,同时活体肾移植急性排斥反应临床表现不典型,耐激素排斥率较高,因此在临床工作中应密切观察肾功能变化,及时发现,及时处理。

BACKGROUND：Clinical practice has confirmed that acute rejection is not rare during living renal transplantation.Steroid-resistant-induced rejection commonly occurs, and the clinical manifestation is not typical, so it is easy to do missed diagnosis and misdiagnosis.If severity, it will induce transplantation failure, and affect human/kidney long-term survival rate.OBJECTIVE：To discuss clinical characteristics and prognosis of acute rejection in living renal transplantation METHODS：Clinical date of 168 patients who received cadaver renal transplantation and 192 patients who received living renal transplantation from February 2005 to September 2008 were retrospectively analyzed, including clinical symptoms, complication and therapeutic outcomes.Acute rejection features of living renal transplantation were analyzed.RESULTS AND CONCLUSION：The incidence of acute rejection and corticoid-resistent acute rejection in living and cadaver renal transplantation were 9.8%, 46.2 % and 22.8 %, 57.8% （P0.05）.The symptoms of fever, hematuria, oliguria, transplanted renal pain and complication of infection, perirenal hematoma were less in acute rejection patients with living renal transplantation.All 19 cases of acute rejection with living renal transplantation were reversal; of 38 cases, 35 cases of acute rejection with cadaver renal transplantation were reversal; 2 cases transplanted renal fracture; 1 case with renal vein thrombus.Clinical analysis has indicated that the incidence of acute rejection and corticoid-resistent acute rejection in living renal transplantation were less than cadaver renal transplantation.Clinical symptoms were light, easy to reversal.But, the incidence of corticoid-resistent acute rejection in living renal transplantation was still high, so we must pay attention to kidney function and clinical symptom, and treated immediately.