免疫抑制方案对移植肾早期各种功能状态的治疗影响

目的：分析肾移植术后早期 不同的肾功能状态下，三种免疫抑制用药方案对移植效果的影响。方法：将1196例肾移植患者根据其初始的免疫抑制用药方案分为A、B、C三组。A组：环孢素A（CsA) 硫唑嘌呤(Aza) 泥尼松（Pred);B组：CsA 霉酚酸酯（MMF）＋Pred;C组：他克莫司（FK506）＋MMF（或Aza) Pred。根据移植后早期肾功能状态，将患者分成肾功能即刻恢复正常（IGF）、缓慢恢复正常（SGF）、未恢复正常（AGF）和延迟恢复正常（DGF）四种情况。统计四种肾功能状态下，A、B、C三组患者的1年移植肾存活率、急性排斥发生率及治疗逆转率、药物副作用和相关并发症。结果：在四种不同肾功能状态下，B组或C组患者的移植肾1年存活率高于A组；B组和C组的急性排斥发生率均低于A组，急性排斥反应逆转率高于A组，但差异无显著性；B组或C组的肝功能损害、肾毒性、高血压的发生率明显低于A组。结论：在肾移植后各种肾功能状态下，B组和C组的免疫抑制方案，都可减少急性排斥反应、药物毒副作用及相关并发症的发生率，提高移植肾的存活率。     

HLA配型对群体反应性抗体阳性的肾移植受者人/肾存活率的影响

目的探讨HLA交叉反应组（CREGs）配型对群体反应性抗体（PRA）阳性肾移植受者人／肾存活率的影响。方法应用美国莱姆德公司LAT1240、LM720R、SSP2LB试剂，准确检测112例PRA阳性肾移植受者体内PRA的水平及其抗体的特异性，评估其致敏状态，应用CREGs配型标准选择最匹配的供者。结果112例受者中，HLA-Ⅰ类抗体阳性43例，Ⅱ类抗体阳性39例，Ⅰ、Ⅱ类抗体均为阳性30例；HLA配型0～5个位点错配数分别为6、39、38、21、7、1例，术后移植肾发生加速性排斥反应2例、急性排斥反应18例、慢性排斥反应5例、移植肾功能延迟恢复（DGF）4例，因排斥反应导致移植肾切除1例，死亡13例（其中移植肾带功能死亡5例）。目前人存活99例，肾存活96例，5年、3年和1年肾存活率分别为86．21％、86．96％和91．96％。结论运用CREGs配型原则，能使供、受者间的HLA相配率显著提高，可减少PRA对肾移植的不良影响，提高PRA阳性受者的人／肾存活率。     

移植肾功能延迟恢复对长期存活的影响

目的 探讨移植肾功能延迟恢复对肾移植受者人／肾长期存活的影响。方法 回顾分析５７３例肾移植中发生的７０例移植肾功能延迟恢复受者的人／肾存活情况及其相关危险因素。结果 ７０例患者总的１、３、５年人存活率分别为７７．１％、４７．６％、３７．５％,肾存活率分别为７１．４％、４０．５％、１５．０％,明显低于同期未发生肾功能延迟恢复的受者,但未合并排斥反应的移植肾功能延迟恢复者存活率并不受影响,合并排斥反应     

移植肾功能延迟恢复的临床诊治体会

目的．探讨肾移植术后移植肾功能延迟恢复（DGF）的病因及治疗方法。方法分析本组发生的43例肾移植术后DGF患者的临床资料，主要原因：急性排斥（AR）17例（39．5％），急性肾小管坏死（ATN）16例（37．2％），输尿管梗阻4例（9．3％），免疫抑制剂肾毒性4例（9．3％），动脉吻合口狭窄2例（4．6％）。经血液透析治疗16例，ATG／ALG或OKT3治疗12例，外科手术6例。结果36例肾移植术后8—113d（平均23．8d）肾功能恢复正常，2例肌酐在176—300μmol／L之间，4例恢复血透，1例死于肺部感染。结论AR和ATN是引起肾移植术后DGF的主要因素，术前严格配型、合理筛选受者及保证供肾质量等是成功的关键。     

儿童肾移植(附26例报告)

目的：探讨儿童肾移植手术技巧及术后免疫抑制剂的应用特点，提高人／肾存活率。方法：分析26例儿童肾移植患者的手术、免疫抑制剂使用和长期存活情况等临床资料。结果：移植肾功能延迟恢复2例，急性排斥反应（AR）11例，慢性排斥反应10例，1例肾移植2周后发生复发性肾炎，病理显示为局灶性节段性肾小球硬化，治疗后肾功能尚可维持；1、3、5年人／肾存活率分别为96％／88％，92％／73％和88％／62％，总死亡率12％。结论：良好的组织配型、适宜的手术方法、AR早诊断和恰当的血药浓度是保证儿童肾移植成功的关键。     

2300例次肾移植的临床分析

目的：对1972－2000年10月间2300例次肾移植情况进行临床分析,方法：统计肾移植后受者1、3、5年的人、肾存活率;肾移植主要并发症及其处理原则;影响受者再次移植存活率的因素;HLA－A－抗原／基因配型及群体反应抗体（PRA）检测情况。结果（1）自1985年使用环孢素A（CsA)后1年人、肾存活率（人、肾均存活）为87．33％,3年为80．17％,5年为67．04％。（2）50岁以上肾移植患者353例,1年移植肾存活率83．44％（252／302）,1年人存活率85．43％（258／302）。（3）肾移植术后患者心脑血管系统疾病占死亡原因的50．7％,感染占死亡率的13．5％,（4）恶性肿瘤的发病率为1．46％（23／1580）。（5）良好的HLA供－受者配型型可减少术后急性排斥反应的发生率,利用于移植肾的长期存率。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和及时治疗是提高肾移植术后 人／肾存活率的重要因素。     

亲属活体供肾移植与尸体供肾移植的临床疗效比较

目的比较HLA配型和免疫抑制方案相同情况下亲属活体供肾移植与尸体供。肾移植的临床效果。方法对12例亲属活体供肾移植供、受者的临床资料进行回顾性分析，并与22例同期进行的、HLA配型情况相近的尸体供肾移植的临床资料进行对比，分析各组术后人／肾1年及3年存活率、1年内急性排斥反应发生率及3年内的。肾功能。结果12例供者均无手术并发症，术后肾功能正常，生活及工作未受明显影响。术后1年内的急性排斥反应发生率，亲属活体供。肾组和尸体供。肾组分别为16．7％和22．7％（P〈0．05）；人／肾1年和3年存活率，亲属活体供肾组分别为100％（12／12）／91．7％（11／12）和91．7％（11／12）／83．3％（10／12），尸体供。肾组分别为100％（22／22）／90．9％（20／22）和95．4％（21／22）／86．4％（19／22），两组比较，差异无统计学意义（P〉0．05）；3年内的。肾功能，亲属活体供肾移植组明显优于尸体供肾移植组（P〈0．05）。结论在HLA配型和免疫抑制方案相同的情况下，亲属活体供。肾移植的临床效果优于尸体供。肾移植。     

合并海洋性贫血的尿毒症患者肾移植的临床观察

目的探讨海洋性贫血对尿毒症患者肾移植效果的影响。方法为46例合并海洋性贫血的尿毒症患者施行。肾移植（海洋性贫血组），其中α海洋性贫血26例，β海洋性贫血20例，观察患者术后移植。肾功能恢复延迟（DGF）和排斥反应的发生率以及贫血的纠正情况，对于移植。肾功能恢复正常者，记录其。肾功能恢复正常的时间，并测定血肌酐值。以同期施行的131例。肾移植（均伴有程度不等的贫血，但非海洋性贫血）为对照。结果海洋性贫血组DGF的发生率为26．1％，对照组为23．7％，二者比较，差异无统计学意义。术后6个月，人、肾均存活，且未失访的患者，海洋性贫血组有39例，对照组有109例，6个月内，海洋性贫血组30．8％发生排斥反应，对照组32．1％发生排斥反应，两组比较，差异无统计学意义；海洋性贫血组的血肌酐值为（121±20）μmol／L，对照组为（128±33）μmol／L，两组比较，差异无统计学意义；海洋性贫血组79．5％的贫血得到纠正，对照组76．1％的贫血得到纠正，两组比较，差异无统计学意义。结论合并海洋性贫血的尿毒症患者可接受肾移植治疗，临床效果与不合并该病者相仿。     

862例肾移植患者应用他克莫司的临床经验

目的 探讨肾移植患者术后长期应用他克莫司（FK506）的疗效和安全性。方法 （1）选取1997至2005年肾移植术后长期应用FK506的患者862例，根据患者的年龄分为儿童组（〈18岁）18例，成人组（≥18岁，≤60岁）692例，高龄组（〉60岁）152例；根据术前是否有糖尿病分为糖尿病组（164例）和非糖尿病组（698例），比较各组间1、3、5年的人／肾存活率、排斥反应率及毒副反应发生率。（2）选择上述应用FK506的糖尿病患者164例（FK506组），另选同期肾移植术后应用环孢素A（CsA）的糖尿病患者126例（CsA组），比较两组1年内高血糖发生率及胰岛素的应用情况。结果 （1）儿童组、成人组和高龄组的1年人／肾存活率（％）分别为93．8／93．8、98．8／97．2和97．8／95．7；3年人／肾存活率（％）分别为91．7／83．3、96．5／87．3和94．7／93．3；儿童组1、3年人／肾存活率略低于成人组和高龄组，但三组间比较，差异均无统计学意义（P〉0.05）。儿童组有3例患者均带肾存活超过5年，成人组和高龄组的5年人／肾存活率（％）为87．5／84．4和90．4／85．7。糖尿病组1、3、5年人／肾存活率（％）分别为96．5／94．4、91．5／84．1和88．2／82．4，非糖尿病组为98．2／97．3、97．1／89．1和89．7／87．2，两组比较，差异无统计学意义（P〉0．05）。862例患者的1、3、5年的急性排斥反应发生率分别为9．9％、12．69％和16．07％；3、5年的慢性排斥反应发生率分别为5．25％和12．5%。FK506的毒副作用有肝功能损害、肾中毒、感染等，其发病率分别为7．54％、5．33％和12．41%，神经、精神毒性和脱发的发生率为15．89％和4．76％。非糖尿病组的糖代谢紊乱发生率为16．7％。（2）FK506组术后1个月有112例（68．3％）使用胰岛素，平均剂量为32．72IU／d，术后1年有63例（38．4%）使用胰岛素，平均剂量为13．46IU／d；CsA组术后1个月有78例（61．9％）使用胰岛素，平均剂量为29．08IU／d，术后1年有40例（31．79／）使用胰岛素，平均剂量为12．29IU／d。结论 肾移植术后长期应用FK506可降低排斥反应发生率，提高移植肾存活率。FK506是一种安会有效的基础免疫抑制剂，也适用于儿童和高龄患者。     

血液透析和腹膜透析对肾移植术后并发症和预后的影响

目的 探讨血液透析(HD)与腹膜透析(PD)对肾移植术后并发症和预后的影响。 方法 回顾分析402例术前维持性透析超过3个月的同种异体尸体肾移植术患者的临床资料。按透析方式将患者分为HD组（303例）和PD组（99例），并对345例随访（30.2±15.2）月。比较术前HD和PD对肾移植术后受者和移植肾存活率以及肾移植术后并发症，包括急性排斥、移植肾功能延迟恢复（DGF）、感染、慢性排斥等的影响。 结果 除了术前平均透析时间PD组长于HD组，乙型肝炎（乙肝）感染率HD组明显高于PD组外，在原发病、年龄、性别、血压、血红蛋白、HLA配型、冷热缺血时间、丙型肝炎感染等方面两组间差异无统计学意义。移植术后两组在DGF、急性排斥、慢性排斥、巨细胞病毒（CMV）感染和其他感染的发生率等方面差异无统计学意义。HD组术前透析时间>12个月的患者急性排斥的发生率显著高于<12个月的患者（P ＜ 0.05）。乙肝患者比非乙肝患者更易发生移植肾丧失功能（19.23% 比 8.86％，P = 0.021）。PD组乙肝病毒阴性的患者术后感染发生率较低。术后患者1年和5年存活率在两组间差异无统计学意义（1年：HD 94.34%，PD 91.25%；5年：HD 92.83%，PD 90%）；同样移植肾1年和5年存活率两组间差异也无统计学意义（1年：HD 93.21%，PD 96.25%；5年：HD 87.17%，PD 91.25%）。 结论 HD和PD对肾移植术后并发症、患者及移植肾1年和5年存活率的影响相似，均可作为慢性肾衰竭患者肾移植术前替代治疗。HD患者的急性排斥发生率随着透析时间的延长而增加，因此，缩短肾移植前透析时间将有助减少肾移植术后并发症。     

Similar impact of slow and delayed graft function on renal allograft outcome and function

Kidney transplant patients can be divided into three groups, according to the initial graft function. First-week dialyzed patients form the delayed graft function (DGF) group. Nondialyzed patients are divided into slow graft function (SGF) or immediate graft function (IGF) according to whether the day 5 serum creatinine was higher versus lower than 3 mg/dL, respectively. SGF patients showed worse graft survival, above higher incidence of acute rejection and lower renal function than IGF patients, although few reports have analyzed outcomes in these groups. We analyzed the impact of SGF on graft survival, first-year renal function, and incidence of acute rejection in 291 renal transplant patients. Creatinine was significantly worse at 12 months for SGF and DGF than for IGF patients (1.9 +/- 0.8 mg/dL, 1.8 +/- 0.7 mg/dL, 1.5 +/- 0.5 mg/dL, respectively; P < .05). There was no difference in first-year renal function between SGF and DGF. The acute rejection rate was higher among the SGF than the IGF group (45% vs 21%, P < .05), but not different from DGF patients (42%, P < .05). Graft survival was better among IGF than SGF or DGF patients, with no significant difference between the last two groups (3-year graft survival, 82%, 71%, 70%, respectively; log-rank test, P < .05). Kidney transplant recipients who develop SGF have a worse outcome than patients with IGF, similar to DGF patients. SGF patients show worse graft survival, worse renal function, and higher acute rejection rates than IGF patients, despite not needing dialysis.     

再次肾移植受者和移植肾长期预后影响因素分析

目的探究再次肾移植受者和移植肾存活情况及长期预后影响因素。 方法回顾性分析1991年1月1日至2017年12月31日于浙江大学医学院附属第一医院肾脏病中心接受肾移植受者临床资料。共纳入再次肾移植受者37例,首次肾移植受者5 374例。根据再次肾移植受者移植肾存活时间长短,将其分为长期存活组(19例,>5年)和短期存活组(18例,≤5年)。采用成组t检验比较长期和短期存活组供受者年龄、首次与再次肾移植间隔时间、HLA错配数和再次移植供肾冷/热缺血时间。采用卡方检验比较长期和短期存活组受者性别、再次移植供肾类型、再次移植前后群体反应性抗体阳性比例、首次移植失功移植肾切除比例、再次移植前免疫诱导比例及再次移植后移植肾功能延迟恢复(DGF)和急性排斥反应发生比例。采用Kaplan-Meier法分析再次和首次肾移植受者/移植肾1、5和10年存活率。采用Cox比例风险模型分析影响再次肾移植术后移植肾长期存活影响因素。P<0.05为差异有统计学意义。 结果截至2018年3月1日,37例再次肾移植受者中位随访时间为152个月(11～323个月),2例死亡,18例发生移植肾失功,17例移植肾功能稳定。5 374例首次肾移植受者中位随访时间为108.9个月(0.1～350.0个月),459例死亡,1 343例发生移植肾失功。再次移植组受者/移植肾1、5和10年存活率分别为86%/81%、86%/62%和82%/36%,首次移植组受者/移植肾1、5和10年存活率分别为99%/98%、93%/89%和88%/80%。再次移植组移植肾1、5和10年存活率均低于首次移植组(χ²＝60.816、25.110和43.900,P均<0.05);再次移植组受者1年存活率低于首次移植组,差异有统计学意义(χ²＝40.409,P<0.05)。长期和短期存活组受者再次移植后移植肾DGF和急性排斥反应发生比例差异均有统计学意义(χ²＝4.039和4.748,P均<0.05)。Cox回归分析结果示DGF和急性排斥反应是影响再次肾移植受者移植肾长期存活的独立危险因素,差异有统计学意义(RR＝4.317和4.571,P均<0.05)。 结论再次肾移植受者移植肾存活率低于首次肾移植受者,DGF和急性排斥反应是影响再次移植受者移植肾存活的独立危险因素。     

Reduced graft function (with or without dialysis) vs immediate graft function--a comparison of long-term renal allograft survival.

BACKGROUND: Delayed graft function (DGF) is a common complication in cadaveric kidney transplants affecting graft outcome. However, the incidence of DGF differs widely between centres as its definition is very variable. The purpose of this study was to define a parameter for DGF and immediate graft function (IGF) and to compare the graft outcome between these groups at our centre. METHODS: The renal allograft function of 972 first cadaveric transplants performed between 1990 and 2001 in the Republic of Ireland was examined. The DGF and IGF were defined by a creatinine reduction ratio (CRR) between time 0 of transplantation and day 7 post-transplantation of <70 and >70%, respectively. Recipients with reduced graft function (DGF) not requiring dialysis were defined as slow graft function (SGF) patients. The serum creatinine at 3 months, 6 months, 1, 2 and 5 years after transplantation was compared between these groups of recipients. The graft survival rates at 1, 3 and 5 years and the graft half-life for DGF, SGF and IGF recipients were also assessed. RESULTS: Of the 972 renal transplant recipients, DGF was seen in 102 (10.5%) patients, SGF in 202 (20.8%) recipients and IGF in 668 (68.7%) patients. Serum creatinine levels were significantly different between the three groups at 3 and 6 months, 1, 2 and 5 years. Graft survival at 5 years for the DGF patients was 48.5%, 60.5% for SGF recipients and 75% for IGF patients with graft half-life of 4.9, 8.7 and 10.5 years, respectively. CONCLUSION: This study has shown that the CRR at day 7 correlates with renal function up to 5 years post-transplantation and with long-term graft survival. We have also demonstrated that amongst patients with reduced graft function after transplantation, two groups with significantly different outcomes exist.     

Early Graft Function After Living Donor Kidney Transplantation Predicts Rejection But Not Outcomes

Poor early graft function (EGF) after deceased donor kidney transplantation (DDKT) has been intensely studied. Much less is known about poor EGF after living donor kidney transplantation (LDKT). Data were collected on 469 LDKTs performed between 1/1/97 and 12/31/01 to determine risk factors for and outcomes associated with poor EGF, defined as either delayed or slow graft function (DGF or SGF). The incidence of DGF and SGF were 4.7% and 10.7%, respectively. Diabetic etiology (OR 2.22; p = 0.021) and warm ischemia time (WIT) (OR 1.05 per min increment; p = 0.0025) emerged as independently associated with poor EGF. Neither functional graft survival nor 1-year graft function differed among the EGF groups. However, DGF and SGF strongly predisposed to acute rejection (AR), which compromised functional graft survival (p = 0.0007) and 1-year graft function. Therefore, we conclude that diabetic etiology of renal disease and WIT are the dominant risk factors for poor EGF after LDKT. Poor EGF did not directly compromise functional graft survival but strongly predisposed to AR. We suggest that immunosuppression should be intensified in the poor EGF setting to maximize LDKT longevity, as AR does impair functional graft survival.     

Immunosuppression for delayed or slow graft function in primary cadaveric renal transplantation: use of low dose tacrolimus therapy with post-operative administration of anti-CD25 monoclonal antibody

BACKGROUND: Patients who develop delayed graft function (DGF) following cadaveric renal transplantation have inferior survival to those who do not. Calcineurin inhibitors (CNI) may prolong recovery from DGF. Patients with DGF are therefore routinely treated with either polyclonal antilymphocyte preparations or monoclonal anti-CD3 monoclonal antibodies and delayed introduction of CNI. The purpose of this study was to evaluate the efficacy of the anti-CD25 monoclonal antibody basiliximab (BSLIX) started post-operatively in patients at high risk for DGF combined with low dose tacrolimus (TAC). METHODS: Patients who received a primary cadaveric renal transplant only after August 1998 were included in this retrospective study (n = 143). All patients received TAC and mycophenolate Mofetil (MMF) pre-operatively. At 6 h post-operatively, graft function was assessed clinically by urine output and serum creatinine. Those patients who had a urine output < 300 cc/6 h or a rising serum creatinine were presumed to be at risk for DGF (n = 46). These patients were treated with 20 mg BSLIX and had TAC dose reduced to maintain a trough blood level of < 5 ng/mL. Basiliximab was repeated at day 5. Patients not felt to be at risk for DGF were treated with standard TAC dose with trough level target of 9-12 ng/mL. Patients at risk were classified as DGF if they needed dialysis or as slow graft function (SGF) if they did not. The combined group (SGF/DGF) were analysed together. Patients with SGF/DGF had their TAC dose increased to achieve trough levels of 9-12 ng/mL when renal function improved. Patient groups were compared for demographics, need for dialysis, serum creatinine, glomerular filtration rate (GFR), TAC trough levels, MMF dosage, complications and 1- and 2-yr actuarial graft survival. RESULTS: Patients with SGF/DGF had a longer length of stay (8 vs. 5.7 d), were more likely to be black (41.3 vs. 25.7%), and required more post-operative haemodialysis (HD) (52.2 vs. 4.1%). SGF/DGF and non-SGF/DGF patients had similar rates of rejection (28.2 vs. 19.6%, p = 0.28) and steroid resistant rejection (SRR) (6.5 vs. 2.1%, p = 0.32). There were no differences in the rate of cytomegalovirus (CMV) infection (4.3 vs. 6.1%). Serum creatinine was higher and GFR lower at all time points in the SGF/DGF patients. The 1 and 2 yr actuarial survival in the non-SGF/DGF patients was 97.6 and 97.6% compared with 1 and 2 yrs actuarial survival of 94.1% and 80.0% in the SGF/DGF patients, p = 0.04. There were no differences in patient survival. There were no differences in actuarial survival for the SGF/DGF patients who received dialysis compared with those who did not receive dialysis. Comparison of patients who received HD (n = 28) to those who did not (n = 115), regardless of group demonstrated no difference in 1 and 2 yrs actuarial survival, 100 and 94.1% in HD patients vs. 98.2 and 92.5% in non-HD patients. CONCLUSIONS: The clinical diagnosis of SGF/DGF can be made 6 h post-operatively based on urine output and serum creatinine. Basiliximab can be started post-operatively in these patients and decreased levels of TAC can be used to achieve acceptably low rates of rejection in these patients. However, SGF/DGF patients, regardless of their need for dialysis, have worse function at 1 yr and lower 2-yr actuarial graft survival compared with non-SGF/DGF patients. Most of the poor survival can be attributed to the SGF group. Further strategies to either prevent SGF/DGF or to optimize treatment in these patients are needed.     

Comparisons of clinicopathological correlations between immediate and slow graft function in renal transplant recipients

Abstract: The functional recovery state of renal transplants can be divided into three types: immediate graft function (IGF), slow graft function (SGF) and delayed graft function (DGF). In contrast to the well-known clinical outcomes for IGF and DGF, the pathological findings and clinical outcomes of SGF are undetermined. This study evaluated possible clinicopathological correlations in 237 patients with SGF compared with patients with IGF. IGF and SGF were defined by serum creatinine levels (IGF < 1.2 mg/day l; SGF: ≥1.2 mg/dL) at day 14 after renal transplantation. Graft biopsy was performed on this day, and pathological classification was performed using the Banff schema. The SGF group of patients ( n  = 121) showed higher rates of cadaver donors and male recipients than the IGF group ( n  = 116), but there were no significant differences in recipient or donor age, numbers of HLA mismatches, types of immunosuppressant or follow-up periods between two groups. The SGF group showed higher serum creatinine levels at discharge, and a higher incidence of acute rejection than the IGF group (24.8% vs. 8.6%, P  < 0.05) and lower graft survival rates (1 year, 93.3% vs. 100%; 5 years, 85.4% vs. 98.6%, respectively; P  < 0.05). The presence of acute rejection in the SGF patients indicated a significantly decreased 5-year survival rate compared with the IGF group. The SGF group of patients with borderline pathology had a higher incidence of acute rejection than the IGF group, and significant increases in the expression of mRNA for pro-apoptotic genes (Fas-ligand, granzyme B and perforin) compared with the IGF group. In conclusion, SGF represents the activated immune state and is associated with poor graft outcome. Anti-rejection treatment or modified immunosuppressive regimen may thus be indicated for patients with SGF.     

Impact of Slow and Delayed Graft Function on Kidney Graft Survival Between Various Subgroups Among Renal Transplant Patients

Objective

Renal allografts with excellent graft function show good long-term outcomes, while grafts with delayed function have been associated with poor long-term survivals, although few reports have analyzed outcomes among these groups. We compared first-week postoperative graft function among renal transplant patients to analyze the impact of slow graft function (SGF) and delayed graft function (DGF) on graft survival.

Materials and Methods

Renal transplantations were performed from 362 unrelated, 46 related, and 163 deceased donors. Kidney transplant patients were divided into 3 groups according to their initial graft function. First-week dialyzed patients formed the DGF group. Nondialyzed patients were divided into a SGF or an excellent graft function (EGF) cohort according to whether the serum creatinine at day 7 was higher vs lower than 2.5 mg/dL, respectively.

Results

Of the 570 renal transplant recipients, DGF was observed in 39 patients (6.8%), SGF in 64 (11.2%), and EGF in 467 (81.8%). There was no significant difference in SGF vs DGF between patients who received kidneys from unrelated vs related living or deceased donors. Graft survival was worse among the DGF than the SGF or EGF patients, with no significant difference between the last 2 groups. The 6-month graft survivals were 74%, 93%, and 96%; the 3-year graft survivals were 70%, 88%, and 90%, respectively (P < .001).

Conclusions

We observed a similar impact of EGF and SGF on kidney graft survival. Kidney transplant recipients who developed DGF showed worse graft survival than those with EGF or SGF.     

Comparison of outcomes after delayed graft function: sirolimus-based versus other calcineurin-inhibitor sparing induction immunosuppression regimens

BACKGROUND: Sirolimus (SRL) may increase the incidence of or prolong delayed graft function (DGF) after cadaveric renal transplantation. This study compares transplant outcomes of SRL-based induction immunosuppression (IS) with other calcineurin-inhibitor (CNI) sparing regimens in the DGF setting. METHODS: Adult cadaveric renal-transplant recipients who received transplants between January 1, 1997 and June 30, 2001 and experienced DGF (n=132) were divided into three groups by induction IS: A, depleting antibody (n=41); B, SRL (n=49); and C, neither (n=42). All recipients also received steroids and mycophenolate mofetil with delayed initiation of CNIs when good renal function returned. Patient survival, graft survival, and time to rejection within 1 year of transplantation were assessed by Kaplan-Meier analysis. One-year graft function was compared using Kruskal-Wallis and Fisher's exact tests. RESULTS: The SRL group had longer DGF duration (P=0.01). The three groups had comparable patient (P=0.27) and graft survival (P=0.69), but the depleting antibody group experienced less rejection (P=0.004). There were no clinically significant differences in 1-year graft function. CONCLUSIONS: In our analysis of a large and modern cohort of adult cadaveric transplant recipients with DGF, induction immunosuppression with a depleting antibody preparation reduced rejection, whereas SRL prolonged DGF duration. All three CNI-sparing induction IS regimens resulted in comparable patient survival, graft survival, and graft function.     

多囊肾患者肾移植术后的临床效果

目的:探讨多囊肾患者肾移植的特点、并发症及其对移植效果的影响。方法:回顾性分析了42例多囊肾患者和80例非多囊肾患者肾移植的临床资料。对两组患者的术后并发症以及1年和5年的人、肾存活率进行比较。同时对多囊肾组术前切除原肾和不切除原肾的患者进行比较。结果:两组患者在术后移植肾功能延迟恢复,急性排斥反应,心脑血管并发症以及肺部感染的发生率上均无显著性差异。多囊肾组患者术后的泌尿系感染的发生率高于对照组(P<0.05)。多囊肾组和对照组患者,1年和5年人存活率分别为95.24%与97.50%和83.81%与88.92%;1年和5年肾存活率分别为90.48%与94.97%和69.55%与66.54%。多囊肾组术前切除原肾和不切除原肾的两组患者间,上述并发症以及人、肾存活率差异均无统计学意义。结论:多囊肾患者接受肾移植是可行的,术后的人肾存活率与对照组比较差异无统计学意义,不切除原病变肾脏能收到满意的移植效果。多囊肾患者肾移植术后易发生泌尿系感染,应积极采取有效的防治措施。