再次肾移植的临床研究  

Clinical study on renal retransplantation

作　　者：吕忠[1] 朱有华[1] 王亚伟[1] 王立明[1] 周梅生[1] 张雷[1] 张明[1] 韩树[1] 

机构地区：[1]第二军医大学附属长征医院全军器官移植研究所

出　　处：《中华器官移植杂志》2005年第9期542-544,共3页Chinese Journal of Organ Transplantation

摘　　要：目的对再次肾移植进行临床总结。方法回顾性分析86例再次移植患者的临床资料,并与86例首次肾移植患者进行对比分析。首次肾移植失败的原因,17例为超急性排斥反应,9例为急性排斥反应,55例为慢性移植肾肾病,4例为移植肾破裂,1例为严重肾结核;再次移植前,31例群体反应性抗体(PRA)或补体依赖细胞毒(CDC)阳性;再次移植后,16例采用泼尼松(Pred)和硫唑嘌呤(Aza)预防急性排斥反应,70例采用环孢素A(或他克莫司)、Aza(或霉酚酸酯)及Pred组成的三联用药方案,32例再次移植前后接受抗体诱导治疗。结果再移植组人/肾1、3和5年存活率分别为84.8%/61.6%、79.1%/45.3%和58.1%/41.9%,对照组分别为89.5%/79.1%、81.4%/74.4%和67.4%/58.1%,两组人存活率的差异无统计学意义,而各时间段的肾存活率的差异均有统计学意义(P<0.05);术前使用抗体诱导治疗者以及术后采用环孢素A(或他克莫司)预防排斥反应者移植肾1年存活率明显优于未用抗体诱导治疗者和仅用Aza、Pred治疗者;术后排斥反应发生率,再移植组明显高于首次移植组(P<0.05);再移植组术后感染发生率明显高于首次移植者。结论再次移植的肾存活率明显低于首次移植,术后排斥反应和感染的发生率较高;采用抗体诱导治疗有利于再移植肾的存活。Objective To summarize the experiences of kidney retransplantation irom 1978 to Dec. 2002. Methods The clinical data of 86 cases subject to first renal transplantation and 86 cases to second renal transplantation were retrospectively analyzed. The main causes of failure of the first renal transplantation were CAN, while those of the second renal transplantation were HAR, and other complications such as AR, graft rupture and serious graft T. B. PRA or CDC in 31 cases was positive before retransplantation. The clinical data such as antibody-inducing therapy, the protocols of immunosuppression and the survival rates of patients and grafts in these patients were analyzed. Results Survival rates at 1, 3, 5 year of the patient/graft of retransplantation group were 84.8% /61.6%, 79. 1%/45. 3 % and 58. 1%/41. 9% respectively, while those at 1, 3, 5 years of the patient/graft with the first renal transplantation were 89. 5%/79. 1%, 81. 4 %/74. 4 % and 67.4 %/58.1% respectively. No significant difference in the patient survival rates and graft survival rates was observed （P〈 0. 05） between two groups. Triple therapy and antibody-inducing therapy improved graft one-year survival rates. The incidence of hyperacute rejection, acute rejection and infection after renal retransplanration was higher （P〈0. 05）. HAR was the main cause of retransplantation failure, and cardiocerebral vascular diseases and infection were the main diseases of the factors of death after renal retransplantation.Conclusion In patients with retransplantation, the survival rates of the graft were lower and the rates of infection were higher due to the worse general conditions. For prolonging the survival rate of the graft, it is necessary to use antibody-inducing therapy and select reasonable patients.

关 键 词：肾移植 再手术 移植物存活 手术后并发症 再次肾移植 临床研究 超急性排斥反应 群体反应性抗体 术后排斥反应 慢性移植肾肾病 

分 类 号：R699[医药卫生—泌尿科学]