2000例次肾移植的临床研究

Results of 2000 kidney transplantations

目的 对我院 1972年～ 1999年 5月间 1739例尿毒症行肾移植手术患者 (2 0 0 0例次 )进行临床研究。 方法 总结 1985年以后人 /肾 1、3、5年的存活率 ;肾移植主要并发症及其处理原则 ;影响患者再次移植存活率的因素 ;HLA 抗原 /基因配型及PRA检测。 结果 (1)自 1985年临床使用环孢霉素A(CsA)后其 1年人肾存活率为 87 33% ,3年人肾存活率为 80 17% ,5年人肾存活率为6 7 0 4%。 (2 ) 5 0岁以上肾移植患者 2 82例 ,最高年龄达 75岁 ,5 0岁以上患者肾移植术后 1年移植肾存活率 82 2 7% (2 32 / 2 82 ) ,1年人存活率为 84 75 % (2 39/ 2 82 )。 (3)肾移植术后患者死亡原因中 ,感染居首位。肺部感染的发病率为 4 49% ,死亡率为 34 6 2 % ,其人巨细胞病毒 (CMV)抗体阳性率可高达40 30 % (16 2 / 40 2 ) ,死亡率为 8 0 3% (13/ 16 2 ) ,其中最多表现为CMV间质性肺炎。 (4)本组肾移植术后恶性肿瘤的发病率为 1 46 % (2 3/ 15 80 )。 (5 )肝损坏患者有独特的药代动力学特点。 (6 )良好的HLA供 受者配型可以减少肾移植术后急性排斥反应的发生率 ,有利于移植肾的长期存活。 结论 良好的组织配型、肾移植术后免疫抑制药物的合理应用、对移植术后并发症的预防及及时治疗是提高肾移植术后人

Objective[WT5”BZ] To analyze the clinical results of renal transplantations. [WT5”HZ]Methods[WT5”BZ] From 1973 to 1999,2000 renal transplantations were performed in 1?739 (1 238 males and 501 females ) patients with end stage renal failure. We analyzed the graft survival rates at 1,3,5 years; the main factors contributing to the motality; the factors affecting the survival rate of re transplant grafts; features of cancers after renal transplantation; the effect of CsA on liver function after renal transplantion; the treatments of chronic rejection; the effect of HLA typing on renal transplantation. [WT5”HZ]Results[WT5”BZ] The graft survival rates at 1,3,5 years were 87 33%,80 17% and 67 04% respectively after using CsA since 1985. 282 recipients were over 50 years. The year graft survival rate was 82 27% and the 1 year patient survival rate was 84 75%. Pneumonitis was the dominant factor of death after renal transplantation, the incidence was 4 49%, and the death rate was 34 62%.The incidence of CMV positive after renal transplantation was 40 30%, and the death rate was 8 03%. Patients should wait a longer period(over 6 monthe) if the first transplant was failed because of acute rejection. The incidence of tumor after transplantation was 1 46%.The most frequent site of the tumors was urological system. The patient′s liver function before transplantation and the intraindividual variability of CsA were the major factors on toxicity of the liver. The incidences of acute rejection were 27%,35 5%,22 4%,20 85%,0%,0% respectively when the HLA mismatches were 6,5,4,3,2 and 1. [WT5”HZ]Conclusion[WT5”BZ] Using immunosuppressants reasonablely,preventing acute rejection,achieving good HLA typing are the major factors improving long term graft/patient survival rate. [WT5”HZ]