尸肾移植1806例效果分析  

Outcome of cadaveric kidney transplantation: analysis of 1806 cases

作　　者：陈立中[1] 陈国栋[1] 王长希[1] 费继光[1] 邱江[1] 邓素雄[1] 李军[1] 

机构地区：[1]中山大学附属第一医院器官移植中心,广州510080

出　　处：《中华泌尿外科杂志》2006年第3期166-170,共5页Chinese Journal of Urology

摘　　要：目的探讨影响尸肾移植术后人/肾存活率的危险因素。方法对1984年2月至2003年12月1806例尸肾移植患者的临床资料进行总结,应用Kap lan-M e ier分析计算1、5、10、15和20年人/肾存活率和移植肾半寿期。对可能影响人/肾存活率的各因素,如受者性别、年龄、移植时间、移植次数、透析时间、乙型肝炎表面抗原、移植肾功能恢复延迟(DGF)、急性排斥、慢性排斥、感染、高血压、糖尿病和免疫抑制剂等进行Log-Rank单因素分析和Cox多因素回归分析,找出影响人/肾存活率的独立危险因素。结果总体1、5、10、15、20年人存活率分别为92.28%、87.20%、78.60%、63.45%、47.59%;肾存活率分别为84.61%、73.64%、57.31%、46.77%、31.18%;总体移植肾半寿期为(11.94±0.84)年。2001-2003年的1年人/肾存活率达95.51%和91.72%。单因素和多因素分析表明,高龄、DGF、糖尿病、感染、急性排斥和多次移植是影响移植肾存活率的独立危险因素,而前4者是影响患者存活率的独立危险因素。吗替麦考酚酯(骁悉)可显著提高移植肾存活率。结论骁悉等新型免疫抑制剂的应用显著提高了移植肾存活率,积极防治感染、心脑血管疾病等术后并发症是进一步提高人/肾存活率的关键。Objective To analyze the risk factors affecting patient and graft survival after cadaveric kidney transplantation. Methods The clinical data of 1806 cases of cadaveric kidney transplantation were summarized by calculating the survival of patients and grafts and half-life of grafts,using Kaplan-Meier analysis. Factors such as age and gender of recipients, time and number of transplantation, dialysis time, hepatitis B surface antigen,delayed graft function （DGF） , acute and chronic rejection, infection, hypertension, diabetes and immunosuppressive agents,which may affect patient and graft survival were analyzed by log-rank analysis and Cox model multivariate analysis to find out the independent risk factors. Results The overall 1-,5-, 10-, 15-,20-year patient survival was 92.28 % , 87.20% , 78.60% ,63.45% ,47.59% , respectively. The overall graft survival was 84.61% ,73.64% ,57.31% ,46.77% ,31.18% ,respectively. The overall half-life of grafts was （11.94 ± 0.84） years. The grafts/patient survivals have been improved significantly in recent years. The 1-year patient and graft survivals reached 95.51% and 91.72% , respectively, between 2001 and 2003. Univariate and multivariate analyses showed that old age, DGF, diabetes, infection, acute rejection and re-transplantation are the independent risk factors affecting graft survival, while the first four factors are the independent risk factors impacting on patient survival. MMF can improve the graft survival significantly. Conclusions New immunosuppressive agents such as MMF can improve the graft survival significantly. Preventing and treating complications such as infection and cardio-cerebrovascular diseases is the key to the improvement of patient and graft survival.

关 键 词：肾移植 人/肾存活率 危险因素 

分 类 号：R699.2[医药卫生—泌尿科学] R692[医药卫生—外科学]