再次肾脏移植临床管理及疗效分析——附17例分析

Clinical management and outcome analysis of kidney re-transplantation——report of 17 cases

目的探讨再次肾移植病人临床管理策略及其临床疗效。方法依据解放军总医院第八医学中心和北大国际医院制订的再次肾移植临床管理策略对2017年6月~2019年6月共17例再次肾移植病人规范性管理,均选择公民逝世后器官捐献(DCD)供肾移植,观察术后急性排斥反应(AR)、移植肾功能延迟恢复(DGF)、肺部感染等临床指标。结果二次移植14例(82.4%),三次移植3例(17.6%);移植肾切除5例(29.4%),移植肾保留12例(70.6%);预存抗体阳性脱敏5例(29.4%),抗体阴性非脱敏12例(70.6%)。AR共4例(23.5%),肺部感染共6例(35.3%),DGF共1例(5.9%)。移植肾切除组AR1例(20%)肺部感染1例(20%);移植肾保留组AR3例(25%),肺部感染5例(41.7%)。脱敏组AR1例(20%),肺部2例(40%);非脱敏组AR3例(25%)肺部感染4例(33.3%)。中位随访时间14.5个月(6~36个月),1年人肾存活率94.1%,1例(5.9%)死亡。结论合理规范的临床管理策略可使再次肾脏移植获得较好的临床效果。不切除失功的移植肾病人肺部感染机率明显高于移植肾切除病人。脱敏治疗可以明显降低再次肾脏移植的排斥风险,且不会明显增加感染机会。

Objective To investigate the clinical management strategy and clinical outcomes of kidney re-transplantation.Methods According to the clinical management strategies of kidney re-transplantation of the eighth medical center of PLA General Hospital and Peking University International Hospital,a total of 17 patients who took kidney re-transplantation from donation after citizen death(DCD) in both hospitals from June 2017 to June 2019 were managed in the formulated standardized strategies.The clinical outcomes such as acute rejection(AR),delayed graft function(DGF),pulmonary infection were observed.Results 14 cases(82.4%) were second kidney transplantation and 3 cases(17.6%) were three times transplantation;5 cases(29.4%) with nephrectomy and 12 cases(70.6%) with the previous kidney graft preserved;5 cases(29.4%) endured desensitization because of population reactive antibody positive and 12 cases(70.6%) were negative.There were 4 cases of AR(23.5%),6 cases of pulmonary infection(35.3%) and 1 case of DGF(5.9%).There were 1 case(20%) of AR in the nephrectomy group,1 case(20%) of pulmonary infection;3 cases(25%) of AR and 5 cases(41.7%) of lung infection in the transplantation group.In desensitization group,there were 1 case of AR(20%),2 cases of lung(40%),3 cases of AR(25%) and 4 cases of pulmonary infection(33.3%) in non-desensitization group.Median follow-up time was 14.5 months(6-36 months).The 1-year renal survival rate was 94.1%(16/17 cases) and 1 case(5.9%) died.Conclusion Although kidney re-transplantation recipients were in immunologically high risk,reasonable and standardized clinical management strategy can achieve better clinical outcomes.There are significantly the risk of pulmonary infection after renal transplantation in patients without nephrectomy.Desensitization therapy could significantly reduce the risk of rejection after renal transplantation,and did not significantly increase the risk of infection.