81例成人IgA肾病肾移植的临床疗效

Clinical outcomes for kidney transplantation in 81 adults with IgA nephropathy

目的:免疫球蛋白A肾病(immunoglobulin A nephropathy,IgAN)是最常见的肾病类型之一,肾移植手术是终末期肾病最有效的治疗手段。本研究旨在分析成人IgA肾病肾移植的临床疗效,探讨IgA肾病肾移植围手术期及中远期的有效性与安全性。方法:回顾性纳入2018年1月至2022年1月中南大学湘雅二医院实施的所有81例成人IgA肾病肾移植的临床资料和随访数据。受者年龄(34.1±9.9)岁,其中男性47例(58.0%),体重指数为(20.8±3.2)kg/m2,人白细胞抗原错配数为(3.5±1.2)个。总结受者肾移植手术后第1、5、7天以及出院时的估算肾小球滤过率(estimated glomerular filtration rate,eGFR)及每日24 h尿量情况,综合评估其移植肾恢复情况以及并发症发生情况。评估随访第6、12、24、36、48个月的eGFR、尿蛋白、尿隐血等指标。结果:随访(25.7±15.8)个月。围手术期所有患者均未发生原发性移植肾无功能,51例(62.9%)患者属于移植物功能立即恢复,16例(19.8%)患者属于移植物功能缓慢恢复,两者占总数的82.7%;14例患者出现了移植物功能延迟恢复,占17.3%。共发生19例围手术期并发症,包括急性排斥反应9例、尿瘘5例、双下肢血管血栓1例、淋巴瘘4例。随访第6、12、24、36及48个月的eGFR分别为(65.3±22.9)、(67.6±23.0)、(64.3±21.8)、(65.9±24.7)及(68.7±31.2)mL/(min·1.73 m2)。中长期随访eGFR均保持较高水平,最长随访至56个月,eGFR波动仍较小;末次随访尿蛋白阳性率与尿隐血阳性率较低。移植肾IgAN复发4例,占总患者的4.94%,未出现严重肾功能不全。3例患者因重症肺炎、排斥反应、移植肾结石出现移植肾失功能,总体移植肾存活率达95%以上,随访至2022年1月所有患者存活率100%。结论:成人IgAN肾病肾移植近期效果显著,受者受益明显,中远期效果良好,IgAN复发率较低,且很少引起严重肾功能损害。

Objective:Immunoglobulin A nephropathy(IgAN)is one of the most common types of kidney disease,and kidney transplantation is the most effective treatment for end-stage renal disease.This study aims to analyze the clinical curative effect of renal transplantation for adults with IgAN and to discuss the efficacy and safety of kidney transplantation for IgAN at the perioperative period and medium-and long-term follow-up.Methods:This retrospective study included the clinical and follow-up data of 81 adult patients with IgAN who underwent kidney transplantation at the Second Xiangya Hospital,Central South University from January 2018 to January 2022.Of the 81 patients whose age at(34.1±9.9)years old,47(58.0%)were male.The body mass index was(20.8±3.2)kg/m2,and the human leukocyte antigen(HLA)mismatch number was 3.5±1.2.The estimated glomerular filtration rate(eGFR)and daily 24-hour urine output for the recipients on the 1st,5th,and 7th day after kidney transplantation and when they were discharged were analyzed.The recovery of the transplanted kidney and occurrence of complications were comprehensively evaluated.The eGFR,urinary protein,and occult blood were evaluated at the 6th,12th,24th,36th,and 48th month and at the last follow-up.Results:The follow-up time was(25.7±15.8)months.No primary non-function occurred in any patient during the perioperative period time.Fifty-one(63.0%)patients had immediate graft function recovery,and 16(19.8%)patients had slow graft function recovery.Delayed recovery of graft function was observed in 14(17.3%)patients.A total of 19 perioperative complications occurred,including 9 patients with acute rejection,5 patients with urinary fistula,1 thrombosis in both lower limbs,and 4 lymphatic fistula.The eGFR at 6th,12th,24th,36th,and 48th month of follow-up were(65.3±22.9),(67.6±23.0),(64.3±21.8),(65.9±24.7),and(68.7±31.2)mL/(min·1.73 m2),respectively.The eGFR remained high during the medium-and long-term follow-ups.At the longest follow-up of 56 months,eGFR fluctuation was still mild,and the positive rate of urine protein and occult blood was low.IgAN recurred in 4 transplanted kidneys,accounting for 4.94%of the total patients,without severe renal insufficiency.Three patients had kidney dysfunction due to severe pneumonia,rejection,and stone in the transplanted kidney.The overall survival rate of the transplanted kidney was higher than 95%,and the survival rate of all patients was 100%till Januray 2022.Conclusion:Renal transplantation for adults with IgAN had a remarkable short-term effect.The recipients can be beneficial significantly to favorable midium-and long-term outcomes.IgAN recurrence is infrequent and rarely causes severe renal function damage.