肾移植术后移植肾带功死亡原因分析

目的：分析19例肾移植术后移植肾带功死亡原因，为临床防治移植肾带功死亡提供参考。方法：回顾性分析19例移植肾带功死亡者的临床资料。结果：感染死亡12例，其中肺部感染10例(5例混合感染、2例单纯感染、3例不明原因的肺部感染)，术后尿漏引起菌血症2例(均为混合感染)；心脑血管意外死亡5例，均为50岁以上(其中脑出血2例、急性左心衰2例、DIC 1例)；恶性肿瘤死亡2例(均为淋巴瘤)。结论：感染是移植肾带功死亡的最常见原因，与术后免疫状态低下和手术并发症有关，其中肺部感染最重要，移植后肺间质纤维化可能与感染或某些免疫抑制剂有关；心脑血管意外多发生于老年人，术前术后多有难治性高血压及心功能不全；恶性肿瘤的发生与术后免疫力低下有关。防止肾移植术后带功死亡的关键在于预防，对于引起术后带功死亡原因要早发现、早诊断、早治疗，合理调整免疫抑制剂。

Analysis of the cause of death in renal recipients with functional renal allograft

Objective: The cause of death in renal recipients with functional renal allograft has been seldom reported in China. In this study, we analyzed the causes of death in 19 renal recipients who died with a functional renal allograft in our hospital. Methodology: Between Dec 1993 and Oct 2002 in our hospital, 659 patients received a cadaveric renal allograft and 81 patients died. Among the 81 deceased, 19 (23.5%) died when their serum creatinine levels below 200 mmol/L. The causes of death in these 19 cases were analyzed retrospectively. Results: In 12 cases, severe infections were identified as the cause of death, including 10 pulmonary infections and 2 bacteremia associated with urinary tract leakage. Cadiovascular or cerebral vascular causes of death were identified in 5 of the patients, including 2 with cerebral vascular hemorrhage, 2 with acute left heart failure, and 1 with DIC. Lymphoma was diagnosed in the other 2 patients. Old age was identified as a risk factor for vascular cause of death in the group of patients. Conclusion: Infection ranked the first in the list of cause for death in this group of patients. Immunosuppressive treatment and surgical complications might contributed to the preposition for infections. Old age and hypertension are associated with vascular complication. Malignancy might be associated with long- term immunosuppressive treatment.