肾移植治疗狼疮性肾炎终末期肾病的临床效果

CLINICAL EFFECT OF KIDNEY TRANSPLANTATION IN TREATMENT OF LUPUS NEPHRITIS END-STAGE RENAL DISEASE

目的评估肾移植治疗狼疮性肾炎终末期肾病(LN-ESRD)的效果和安全性。方法收集1997年9月—2020年12月于我院行肾移植手术LN-ESRD病人的临床资料。所有病人术前已将狼疮性肾炎(LN)控制在稳定期并进行术后随访。对移植术后感染率、急性排斥反应发生率、LN复发率、移植物和病人生存率进分析,并与国内外大样本非移植LN-ESRD病人的预后指标进行对比。结果最终23例病人被纳入研究,女性占87.0%,移植时年龄(33.8±8.2)岁,平均随访时间(12.1±4.4)年。4例病人共发生5次急性排斥反应;1例病人发现有系统性红斑狼疮(SLE)肾外表现,但其组织学上无LN复发证据。经肾移植治疗病人10、15年的累积生存率分别为95.2%和81.6%,而大宗流行病学研究结果显示,仅经透析治疗病人10、15年的生存率分别为33.0%~89.0%和62.9%~79.3%。本研究中肾移植治疗病人感染等并发症发生率比文献报道的保守治疗病人低。结论肾移植可以作为治疗LN-ESRD的有效手段,其临床效果及预后要优于保守治疗。

Objective To investigate the efficacy and safety of kidney transplantation in the treatment of lupus nephritis end-stage renal disease(LN-ESRD).Methods Clinical data were collected from the patients with LN-ESRD who underwent kidney transplantation in our hospital from September 1997 to December 2020,and all patients had lupus nephritis(LN)controlled in the stable stage before surgery and were followed up till now.The patients were analyzed in terms of post-transplantation infection rate,acute rejection rate,LN recurrence rate,and survival rates of grafts and patients,which were compared with the prognostic indicators of non-transplantation LN-ESRD patients in large-sample studies in China and globally.Results A total of 23 patients were finally included in the study,and female patients accounted for 87.0%.The mean age at the time of transplantation was(33.8±8.2)years,and the mean follow-up time was(12.1±4.4)years.Among these patients,4 patients experienced 5 episodes of acute rejection,and 1 patient was found to have extrarenal manifestations of systemic lupus erythematosus,but without histological evidence of LN recurrence.The 10 and 15 year cumulative survival rates of the patients treated with kidney transplantation were 95.2%and 81.6%,respectively,and large epidemiological studies showed that the 10 and 15 year survival rates of the patients treated with dialysis alone were 33.0%-89.0%and 62.9%-79.3%,respectively.The incidence of the complications such as infection in the patients receiving kidney transplantation in this study was lower than that in the patients receiving conservative treatment reported in the literature.Conclusion Kidney transplantation can be used as an effective method for the treatment of LN-ESRD,with better clinical efficacy and prognosis than conservative treatment.