47例亲属活体肾移植受者移植肾功能丧失和带移植肾功能死亡的原因分析

The reasons for chronic renal allograft dysfunction or recipients died with functioning graft in 49 cases of living relative donor kidney transplantation

目的分析亲属活体肾移植后移植肾功能丧失和受者带移植肾功能死亡的原因。方法回顾性分析2006年1月至2013年9月间47例亲属活体肾移植后发生移植肾功能丧失和受者带功能死亡的受者临床资料。将受者分为带移植肾功能死亡组（18例）和移植肾功能丧失组（29例），对受者的功能丧失和死亡原因进行分析。结果慢性移植肾功能丧失的原因依次为术后排斥反应（82．80％），慢性肾病原发或复发（10．30％），以及围手术期外科并发症（6．90％）。所有带移植肾功能死亡受者的死亡原因依次为肺部感染（61．11％），心脑血管疾病（22．22％），肝功能衰竭（11．11％），以及急性血行播散性肺结核（5．56％）。结论早期慢性排斥反应是导致移植肾功能丧失的主要原因，肺部感染和心脑血管疾病是受者带移植肾功能死亡的主要危险因素。加强受者的依从性非常重要。

Objective To analyze the reasons for chronic renal allograft dysfunction （CRAD） and kidney transplant recipients died with functioning graft. Method The clinical data of 49 cases of CRAD or kidney transplant recipients died with functioning graft, who underwent living relative donor kidney transplantation（LDKT） from 2006 to September 2013, were analyzed retrospectively. The data were divided into recipients death with functioning renal graft group （n = 18） and CRAD group （n = 29）. Then the dysfunction/death causes of the two groups were analyzed. Result Generally the dysfunction causes were rejection （82. 80%）, primary or recurrence of the chronic kidney disease （10. 30%）, and perioperative surgical complications （6. 90%）. And the reasons of the death with functioning renal graft were pulmonary infection （61.11%）, cardiovascular and cerebrovascular dises （22. 22 %）, hepatic failure0 （ 11.11%）, and acute blood line disseminated tuberculosis （5.56%）. Conclusion Chronic rejection is the most important factor for CRAD in the early stage after LDKT, Pulmonary infection and cardiovascular and cerebrovascular diseases are the primary risk factor for the death with functioning renal graft in the LDKT recipients. It＇s important to strengthen the compliance of patients.