慢性移植肾失功后再次移植的临床研究

A clinical study of kidney retransplantation of patients with chronic renal allograft dysfunction

目的评估慢性移植肾失功后再次肾移植患者的免疫状态及临床特点,探讨影响再次移植效果的因素。方法分析40例慢性移植肾失功后再次移植患者(A组)的临床资料,并与50例初次移植患者(B组)进行对照。结果术前A组血红蛋白水平低、谷丙转氨酶水平高、心脏病及糖尿病发病率高(P<0.05)。A组急排率(12.5%)与B组(14%)无统计学差异,术后心衰、药物性肝损害、粒细胞减少症发病率增高(P<0.05)。两组血肌酐恢复时间与水平及1年人肾存活率均无显著差异。结论如PRA阴性,慢性移植肾失功后再次移植患者免疫状态可近似初次移植。再次移植患者基础情况差,术后并发症多。如谨慎选择受者,充分术前准备,积极处理并发症,合理使用免疫抑制剂,再次移植后可取得与初次移植近似的疗效。

Objective To investigate the immune status and clinical features of chronic renal allograft dysfunction（CAD）patients who need renal retransplantation, explored the factors influencing the effects of renal retransplantation. Methods From 2003.2 to 2009.2,clinical data of 40 CAD recipients who underwent cadaveric renal retransplantation（group A）was analyzed, compared with a group consisting of 50 cases underwent first kidney transplantation（group B）. Results Before operation,the heamoglobin was lower and the glutamate pyruvate transaminase was higher （P〈0. 05）in group A, while the incidences of diabetes and heart failure were higher（P〈0. 05）. There were no significant difference in the incidences of acute rejection（AR）between two groups, neither were the mean serum creatinine level and 1-year patient and grafts survival rates, while the incidences of drug-induced hepatic injury and heart failure and granulocytopenia were higher in group A（P〈0.05）. Conclusions If PRA was negative before transplantation,the immune status of CAD patients would be closed to or lower than the first renal transplant recipients. The general state of health of CAD patients was worse, and the incidences of postoperative complications were higher. It seemed that kidney retransplantation could yield desirable outcomes, if cautious selection, rational preparation, actively preventing postoperative complications and reasonable use of immunosuppression therapy protocols were performed for CAD patients.