肾移植治疗常染色体显性遗传性多囊肾病患者的临床效果分析(附43例报告)  

Clinical study on kidney transplantation in polycystic kidney disease

作　　者：丁小明[1,2] 薛武军[1,2] 田普训[1,2] 潘晓鸣[1,2] 燕航 侯军[1,2] 冯新顺[1,2] 项和立[1,2] 田晓辉[1,2] 

机构地区：[1]西安交通大学医学院第一附属医院肾病中心肾移植科 [2]西安交通大学医学院器官移植研究所,710061

出　　处：《器官移植》2011年第1期35-38,共4页Organ Transplantation

基　　金：国家自然科学基金(30772096)

摘　　要：目的探讨肾移植治疗常染色体显性遗传性多囊肾病(多囊肾)患者的疗效。方法多囊肾患者43例(多囊肾组),在不切除原双侧肾脏的前提下,进行肾移植,以同期50例原发病为非多囊肾的肾移植患者作为对照组,进行随访研究。比较两组的术后1、3、5年人、肾存活率及排斥反应发生情况,通过肾脏B超检查多囊肾组患者术前与术后移植肾的体积变化,记录多囊肾组的并发症发生情况。结果多囊肾组肾移植术后1、3、5年人存活率分别为95.3%、90.6%、90.6%,术后1、3、5年肾存活率分别为95.3%、88.3%、83.7%。对照组相应为96.0%、92.0%、90.0%,94.0%、92.0%、88.0%,两组比较差异无统计学意义(P>0.05)。两组的急性排斥反应发生率比较差异亦无统计学意义(P>0.05)。多囊肾组术后3～6个月原肾明显缩小,1年后体积基本稳定,跟踪观察1～15年肾脏体积变化不明显。移植后血尿逐渐减轻,7～10d后消失。12例在移植后5～10周反复出现肉眼血尿,均经抗感染治疗后消失。多囊肾患者移植后仍需要应用药物控制血压。多囊肾组尿路感染发生率高达40%。32例多囊肾合并多囊肝,术后发生肝功能损害7例。结论多囊肾患者采用不切除原肾的肾移植效果满意,移植后应严密观察患者移植物肾功能、血尿和感染情况,及时对症处理。Objective To study the outcome of kidney transplantation in autosomal dominant polycystic kidney disease（ADPKD）.Methods Forty-three patients of ADPKD（ADPKD group）underwent kidney transplantation without removing original kidney.And 50 cases undergoing kidney transplantation for other di-seases were chosen as control group.Both groups were followed up during the research.The 1-year,3-year and 5-year survival rates of patients or kidney grafts and rejections were evaluated after kidney transplantation.The sizes of polycystic kidney and transplanted kidney were measured by B ultrasound and the complication was recorded in ADPKD group.Results In the ADPKD group,1-year,3-year and 5-year patient survival rates were 95.3 %,90.6 % and 90.6 %,while 1-year,3-year and 5-year kidney survival rates were 95.3 %,88.3 % and 83.7 %.In the control group,1-year,3-year and 5-year patient survival rates were 96.0 %,92.0 % and 90.0 %,while 1-year,3-year and 5-year kidney survival rates were 94.0 %,92.0 % and 88.0 %.No significant difference of the rates was observed between the two groups（P0.05）.There was no significant difference in the incidence of acute rejection between the two groups（P0.05）.The size of polycystic kidney shrank 3-6 months after transplantation and became steady 1 year after transplantation.And there was no obvious change in the size of polycystic kidney from 1 to 15 years after transplantation.The hematuria was gradually alleviated and disappeared in 7-10 days after transplantation.The gross hematuria was repeatedly observed in 12 cases in 5-10 weeks after transplantation and was cured by anti-infection.The blood pressure of ADPKD patients was efficiently controlled with drug after transplantation.The rate of urinary tract infections for ADPKD group was 40 %.Seven cases of 32 ADPKD patients combined with polycystic liver developed liver function damage after transplantation.Conclusion The satisfactory clinical results can be obtained without removing the original polycystic kidney.Careful monitorin

关 键 词：多囊肾 肾移植 存活率 急性排斥反应 

分 类 号：R692.12[医药卫生—泌尿科学]