临床肾移植524例的疗效分析

Clinical analysis and outcome of 524cases of kidney transplantation

目的探讨器官捐献供者供肾移植的临床疗效,分析影响移植。肾术后移植肾存活的相关因素。方法回顾性分析2007年1月至2015年12月524例器官捐献供者供肾移植的临床资料。记录术后血肌酐水平及估算肾小球滤过率(eGFR);计算术后1、2和3年的受者与移植。肾存活率;记录术后并发症的发生情况。结果所有受者术后中位随访时间17.2个月。术后1、2和3年移植肾存活率分别为97%、95.8%、95.3%,受者存活率分别为97.8%、97%和95.8%。术后1、2和3年的eGFR分别为(67.6±24.1)、(68.9±24.2)和(72.7±26.2)ml/min。术后发生移植物功能恢复延迟(DGF)108例,发生率为20.6%(108/524)。多因素分析结果显示,供者类型(P=0.005)、获取供肾时供者血肌酐水平(P<O.001)与术后发生DGF有关。受者年龄更高(P=0.004)、术前有糖尿病史(P。0.031)、受者术前群体反应性抗体(PRA)阳性(P=0.023)、供者有高血压史(P=0.046)是移植肾存活率的影响因素。结论器官捐献供者供肾移植术后3年的临床疗效良好;受者年龄、术前有糖尿病史、受者术前PRA阳性、供者有高血压史是影响移植肾存活率的独立危险因素。

Objective To explore the clinical outcome of renal transplantation and analyze the risk factors influencing the kidney allograft survival after transplantation.Methods The clinical data of 524 cases of renal transplantation between January 2007 and December 2015 were retrospectively analyzed.Serum creatinine was determined,and glomerular filtration rate(GFR) was estimated.The 1-,2-and 3-year patient and graft survival after transplantation was calculated.Adverse events were recorded.Results The median follow-up time was 17.2 months.The 1-,2-and 3-year graft survival rate after transplantation was 97%,95.8% and 95.3%,respectively.The 1-,2-and 3-year patient survival rate after transplantation was 97.8%,97% and 97%,respectively.The eGFR was (67.6 ± 24.1),(68.9±24.2) and (72.7 ± 26.2) ml·min-1 ·1.73 m-2 at 1st,2nd and 3rd year after transplantation.The incidence of delayed graft function(DGF) was 20.6% (108/524).Multivariate analysis revealed donor type (P =0.005) and the terminal creatinine (P<0.001) were the independent risk factors of DGF.Elder recipients (P =0.004),recipients with diabetes(P =0.031),preoperative positivity of panel reactive antibody(PRA) (P =0.023),and donor with hypertension (P =0.046) were risk factors influencing the kidney allograft survival.Conclusion Kidney transplantation showed good outcomes at 3rd year after transplantation.The recipient age,recipient's history of diabetes,preoperative PRA and donor's history of hypertension are independent risk factors for renal graft survival.