肾移植2200例次临床分析  

Analysis of 2 200 kidney transplantations

作　　者：唐雅望[1] 张玉海[1] 贾宝祥[2] 谢泽林[1] 马琳琳[1] 尔秀江[2] 田野[1] 孙雯[1] 

机构地区：[1]首都医科大学附属北京友谊医院泌尿外科,100050 [2]首都医科大学附属北京友谊医院肾移植研究所

出　　处：《中华医学杂志》2001年第2期82-85,共4页National Medical Journal of China

摘　　要：目的　总结 190 8例 (2 2 0 0例次 )肾移植手术的临床经验 ,提高肾移植术后人、肾存活率。方法　总结 1985年以后人、肾 1年、3年、5年的存活率 ;肾移植主要并发症及其处理原则 ;影响患者再次移植存活率的因素 ;HLA 抗原 /基因配型及群体反应抗体 (PRA)检测。结果　 (1)自 1985年临床使用环孢素A(CSA)后 ,其 1年人、肾存活率为 87 3 % ,3年人、肾存活率为 80 2 % ,5年人、肾存活率为 6 7 0 %。 (2 ) 5 0岁以上肾移植患者 30 2例 ,术后 1年移植肾存活率 83 4% (2 5 2 / 30 2 ) ,1年人存活率 85 4% (2 5 8/ 30 2 )。 (3)肾移植术后患者死亡原因主要是心血管系统疾病及感染。心血管系统疾病占死亡原因的 5 0 7% ,感染占死亡率的 13 5 %。 (4 )肾移植术后恶性肿瘤的发病率为 1 5 % (2 3/15 80 )。(5 )肝损害患者有独特的药代动力学特点。 (6 )良好的HLA供 受者配型可以减少肾移植术后急性排斥反应的发生率 ,有利于移植肾的长期存活。在HLA抗原不配合的情况下 ,受者应尽量选择接受不具有免疫原性抗原 /基因的供肾移植。 (8)对于慢性排斥反应应采取综合方法进行治疗。结论　良好的组织配型、肾移植术后免疫抑制药物的合理应用、对移植术后并发症的预防及及时治疗是提高肾移植术后人、肾存活率的重要因素。Objective To analyze the clinical results of 2 200 renal transplantations Methods The following factors were analyzed: (1) the graft survival rates at 1, 3 and 5 years; (2) main factors contributing to the mortality; (3) factors affecting the survival rate of retransplant grafts; (4) features of cancers after renal transplantation; (5) effect of CSA on liver function after renal transplantion; (6) treatments for chronic rejection; and (7) effect of HLA typing on renal transplantation. Results From 1972 to 2000, 2 200 renal transplantations were performed in 1 908 patients (1 337 men and 571 women) with end stage renal failure in our hospital, Beijing. The graft survival rates at 1, 3 and 5 years were 87.3%, 80.2% and 67.0% respectively, after using CSA since 1985. 302 recipients were aged over 50 years whose one year graft survival rate was 83.4% and one year patient survival rate was 85.4%. Pneumonitis was the dominant death factor after renal transplantation, with an incidence of 4.49% and a death rate of 34.62%. The incidence of positive CMV after renal transplantation was up to 40.3%, in with a death rate of 8.0%. The incidence of tumor after renal transplantation was 1.5%. The most frequent site of tumor was urological system. The patient's liver function before transplantation and the intraindividual variability of bioavailabity to CSA etc. were the major toxic factors of the liver. The incidences of acute rejection were 27%, 35.5%, 22.4%, 20.85%, 0% and 0%, respectively, when the HLA mismatches were 6, 5, 4, 3, 2 and 1. Conclusion Using immunosuppressents reasonably, preventing acute rejection, and achieving good HLA typing are the major factors improving long term graft/patient survival rate.

关 键 词：肾移植 存活率 并发症 临床分析 预防 治疗 

分 类 号：R699.2[医药卫生—泌尿科学]