狼疮肾炎终末期肾病患者尸体肾移植的临床观察

目的　探讨狼疮肾炎终末期肾病 (LN ESRD)患者行尸体肾移植手术的可行性及预后和狼疮活动的情况。方法　回顾性分析我院自 1972年开展肾移植手术以来 6例LN ESRD患者在透析时、术前及术后狼疮活动性指数 (SLEDAI)以及移植的时机、移植后免疫抑制剂的使用和人 /肾存活情况。结果　 6例皆为女性患者 ,皆因LN而出现ESRD。移植前皆接受慢性透析治疗 ,其中透析距移植的时间最短为 3个月 ,最长为 9年。移植后 3例用强的松、环孢素A和霉酚酸酯三联免疫抑制治疗 ,另 3例用泼尼松、环孢素A和硫唑嘌呤治疗。 6例患者有 5例存活至今 ,平均存活 (44± 34 )个月 ,最长为 85个月 ,最短为 4个月。 1例在移植后 4个月因高血压脑出血而死亡 ,死前肾功能正常 ,且无狼疮活动。移植术后 1周内移植肾功能皆恢复正常 ,无 1例因狼疮复发而致移植肾功能减退或丧失 ,其中带肾存活最长且肾功能的保持正常者已达 77个月。在慢性透析期间及移植术后无狼疮活动 (SLEDAI<9分 )。结论　肾移植是治疗LN ESRD成功而有效的手段 ,肾移植后狼疮复发率低。

Cadaveric renal transplantation in patients with lupus nephritis end-stage renal disease

Objective To investigate the possibility of transplantation inlupus nephritis end-stage renal disease (LN-ESRD) and the extent of transplant result and systemic lupus erythematosus (SLE) activity index.Method Retrospective study of activity index (SLEDAI),choice of transplantation,immunosuppressive therapy and patient/graft survival was made in the 6 LN patients who underwent cadaveric renal transplantation during 1972 to 1999.Result These 6 female patients were gone to end-stage renal disease due to LN.Chronic dialysis was done before transplantation.The shortest period between dialysis and transplantation was 3 months,and the longest was 9 years.Three patients were given prednisone,cyclosporine A and imuran as immunosuppressive therapy after transplantation,another 3 patients were given prednisone, cyclosporine A and mycophenolate mofetil (MMF).Five of 6 patients were still alive.The average survival period was (44±33.7) months.The longest was 85 months and the shortest was 4 months.Only one patient died of hypertension cerebropathy 4 months after transplantation,but till death the renal function was still normal and the recurrence of SLE was not seen.One week after transplantation all the graft function recovered to normal.No one had the graft loss because of recurrence of SLE,and the longest graft survival was 77 months.The SLE activity might disappear during dialysis and after transplantation.Conclusion Renal transplantation is effective method to LN patients.And the recurrence of SLE is rare after transplantation.