Long-term results of 1047 cadaveric kidney transplantations with special emphasis on initial graft function and rejection

We studied the effect of initial graft function and acute rejection on graft survival in 1047 cadaveric renal transplantations during 1991–1997 with a constant policy of donor selection, graft allocation, and immunosuppression. The overall 1- and 5-year patient survival rates were 96 % and 88 %, and the 1- and 5-year graft survival (GS) rates were 92 % and 78 %. Delayed graft function (DGF) occurred in 31 % and there were 1.2 % never-functioning grafts. One-year GS in transplantations with early graft function (EGF) was 95 % compared to 87 % in DGF (P < 0.001). Donor age and cause of death, type of graft perfusion and cold ischemia time, and type and length of dialysis treatment were significant factors in determining the onset of graft function. These factors did not have a significant direct effect on GS. Early ( < 100 days) acute rejection occurred in 25 %. In transplantations without rejection, the 1 and 5-year GS was 93.3 % and 80.8 %. In acute rejection responding to steroids, the GS was equal to that up to 3 years, but after that a significantly worse survival rate was observed (1- and 5-year GS: 93.6 % and 73.4 %). DGF was detrimental to GS both in transplantations without rejection and in all rejection types. Received: 4 May 1999/Revised: 9 December 1999/Accepted: 15 December 1999     

肾移植术后早期肾功能恢复对人肾长期存活的影响

目的 探讨肾移植术后早期肾功能恢复情况对人肾长期存活的影响。方法 总结1990-1998年652例肾移植患者资料。根据肾功能恢复情况分为3组：肾功能恢复迅速（IGF）组（A组）473例，肾功能恢复缓慢未行透析治疗（SGF）组（B组）82例，肾功能延迟恢复（DGF）组（C组）97例。对3组患者5、10年人。肾存活率及1年急性排斥反应和带肾死亡情况进行比较分析。结果 A组5、10年人／肾存活率分别为74．0％／70．2％、66．9％／60．3％，B组为64．6％／61．0％、62．2％／42．2％，C组为60．8％／43．3％、55．7％／23．0％。5年人存活率A、B组高于C组，5年。肾存活率A组高于C组，5年人／肾存活率A、B组差异无统计学意义。10年人／肾存活率A组〉B组〉C组，差异均有统计学意义。3组1年急性排斥反应发生率为20．1％、30．5％、43．2％，组间差异有统计学意义。3组1年带肾死亡率为4．7％、4．9％、12．4％，A、B组〈C组，A、B组间差异无统计学意义。急性排斥反应和带肾死亡病例排除后进行比较，3组长期存活率差异无统计学意义。结论 肾移植术后早期肾功能恢复情况对移植患者长期人肾存活有明显影响，DGF患者的影响最明显，SGF预后介于IGF和DGF间。SGF和DGF对长期存活的影响可能源于移植早期较高的急性排斥反应或并发症发生率。     

移植肾功能延迟恢复与供者谷胱甘肽硫转移酶多态性的研究

目的 探讨影响移植肾功能延迟恢复(DGF)的相关因素.方法 收集肾移植受者150例临床资料.其中24例发生DGF,对可能影响DGF发生的各项指标进行统计学分析.提取移植肾供者172例和健康体检者157例外周血中基因组DNA,应用多重PCR和特异性引物多态PCR技术检测谷胱甘肽硫转移酶(GST)基因多态性,比较DGF和无DGF组供者GST基因多态性的差异.结果 受者DGF组和非DGF组性别(χ~2=0.028,P=0.867)、PRA(χ~2=1.564,P=0.211)及透析类型(χ~2=0.585,P=0.444)之间比较差异无统计学意义(P>0.05);单因素线性回归分析提示术后第2个24 h尿量、第1和第2个24 h入量与T_(1/2(SCr))间存在线性关系(P<0.05),Cox风险比例回归模型提示术后第2个24 h尿量可判断受者移植肾功能的恢复情况(RR=1.002,P=0.001).DGF组供者GSTMl基因型缺失频率为86.4%,与未发生DGF组的62.7%、健康对照组的47.8%比较差异有统计学意义(P<0.05).结论 受者术后第2个24 h尿量对预测DGF的发生有重要意义.供者GSTMl基因型缺失可能是发生DGF的原因之一.     

Does delayed kidney graft function increase the risk of chronic rejection?

Abstract  The impact of delayed graft function (DGF) on later renal graft loss due to chronic rejection was studied in a single center using uniform protocol for organ procure merit and post transplant patient care. DGF function was observed in 34 % of 829 consecutive first cadaveric renal transplants in adults and in 47 % of 169 retransplantations (P < 0.05). There were no significant differences in graft survival between groups with early graft function (EGF) and DGF, either in first transplantations or retransplantations. The half-life in EGF and DGF groups of first transplants was 12.3 years and 10.5 years, respectively, and of retransplantants was 8.0 years and 6.5 years, respectively. DGF was divided in three subgroups according to the day of onset. If graft function started during the first or second week after transplantation there were no significant differences in long-term graft survival rates compared with EGF. Only in re-transplants, if graft function started later than 2 weeks postoperatively, were long-term graft survival rates significantly lower when compared with EGF and the difference persisted if other causes of graft loss except chronic rejection were censored.     

The relative influence of delayed graft function and acute rejection on renal transplant survival

Three hundred and eight cadaveric renal transplants were analysed to establish the effects of acute rejection in the first 90 days and delayed graft function (DGF) on graft outcome. There were 120 patients (39%) with no DGF and no rejection (group 1), 101 patients (33%) with rejection but no DGF (group 2), 41 patients (13%) with DGF but no rejection (group 3) and 46 patients (15%) with both rejection and DGF (group 4). The actuarial 4-year graft survival rates for groups 1,2,3 and 40.4%, respectively. The acute rejection rate was 101/221 (46%) in patients with initial graft function compared with 46/87 (53%) for those with DGF (²=1.02, P=0.31). Cox stepwise logistic regression analysis demonstrated that DGF was a more powerful predictive factor for poor graft survival (P=0.001) than acute rejection occurring in the first 90 days post-transplant (P=0.034). Further efforts at improving graft outcome should concentrate on reducing the incidence of DGF.     

肾移植术后肾功能延迟恢复的原因及对策

目的：探讨肾移植术后肾功能延迟恢复(DGF)的原因及处理方法。方法：报告我院发生的33例肾移植术后DGF患者的临床资料,发生DGF的原因是急性排斥15例,急性肾小管坏死(ATN)13例,动脉吻合口狭窄2例。输尿管梗阻2例,环孢素中毒1例。经血液透析治疗31例,ATG／ALG或OKT3治疗28例,经皮移植肾动脉吻合口球囊扩张2例,外科手术2例。结果：29例肾移植术后10～93d(平均24．8d)肾功能恢复正常,2例肌酐在200～300μmol／L之间,1例恢复血透,1例于肾功能恢复正常1月后死于肺部感染。结论：急性排斥反应是引起肾移植术后DGF的主要因素,术前严格配型、合理治疗和耐心等待是成功的关键。     

移植肾功能恢复延迟受者供肾及移植肾活检的意义

目的 分析移植肾功能恢复延迟(DGF)受者进行供肾及移植肾活检对其病因诊断的价值及对治疗的指导意义.方法 回顾性分析144例DGF受者的临床表现、实验室检查特点.获取供肾进行修肾时行供肾活检,在B型超声引导下行经皮肾活检术检查移植肾,分别行组织学、免疫病理和超微病理检查.结果 (1)1994-1997年间DGF的发生率为10.16%,1998-2001年间为7.83%,2002-2005年间为7.48%,2006-2009年降至5.35%;(2)DGF受者的临床表现包括无尿(16.67%)、少尿(16.67%)和高血压(47.22%).123例行移植肾B型超声检查者中肾脏体积增大者占79.67%,血管阻力增高者占45.53%;(3)全部DGF受者均存在血肌酐(SCr)不降或下降缓慢,80例SCr为451～707μmol/L,23例SCr持续＞707μmol/L.70.83%的DGF受者尿N-乙酰-BD-氨基葡萄糖苷酶升高,54.86%的DGF受者尿蛋白定性阳性,53.47%的DGF受者尿沉渣镜检红细胞计数＞50万/ml.(4)144例中,发生急性排斥反应者占45.83%,发生钙调磷酸酶抑制剂肾毒性者占15.28%,IgA肾病者占12.50%,缺血再灌注损伤者占7.64%,移植肾组织学形态正常者占7.64%,急性肾小管坏死者占5.56%,急性间质性肾炎3.47%,移植后复发性疾病占1.39%,肾小球毛细血管内增生性病变占0.69%.(5)60.55%的受者除变更免疫抑制方案外,还进行了肾脏替代治疗.结论 尽管[GF的原因复杂,但供肾质量及移植肾早期病理改变与DGF有直接关系;移植肾活检有助临床更改治疗方案.     

Outcome of renal allografts from non-heart-beating donors with delayed graft function

Delayed graft function (DGF) in renal transplantation using non-heart-beating donors (NHBDs) usually exceeds 80%. There is debate whether DGF in this subgroup is associated with poor long-term outcome. Between 1 January 1988 and 31 January 2000, 130 of 158 (82.3%) NHBD graft recipients with functioning grafts transplanted within our regional NHBD programme developed DGF. Overall graft survival and graft survival censored for recipient death was 113/130 (86.9%) versus 113/121 (93.4%) at year 1, 55/84 (65.5%) versus 55/64 (85.9%) at year 5 and 18/40 (45.0%) versus 18/28 (64.3%) at year 10 after transplantation. Seventeen grafts (13.1%) were lost due to rejection or graft nephropathy. Nine of these kidneys failed during the 1st year. Twenty-seven patients (20.8%) died with functioning grafts, eight within the 1st year after transplantation. In those patients who survived, DGF was associated with excellent long-term outcome in this study. The number of grafts lost due to recipient death exceeded those lost due to rejection or graft nephropathy.     

尸肾移植肾功能延迟恢复70例次总结

本文介绍我院15年来的尸体肾移植情况：肾移植术后功能延迟恢复（DGF）发生率为5．02％，其原因分别为急性肾小管坏死（ATN）占71．4％，急性排斥（AR）及急性加速性排斥（AAR）反应占20．0％，泌尿系并发症占4．29％，肾动脉吻合口狭窄及急性CSA肾毒性各占1．43％。其预防包括：选择年轻健康供者；缩短热、温缺血时间；保存液中引进钙离子持抗剂；水中避免缩血管药物的应用及避免术后泌尿系并发症的发生；经济条件允许者预防性应用单、多克隆抗体；警惕急性CsA肾毒性及肾动脉吻合口狭窄的发生。     

Risk factors for acute rejection in renal transplant recipients experiencing delayed graft function

Acute rejection (AR) superimposed upon delayed graft function (DGF) following renal transplantation worsens graft outcomes. However, risk factors for AR in patients displaying DGF remain unclear. In this study, 71 patients displaying DGF >/= 5 d were investigated. All received cyclosporine, adjunctive azathioprine or mycophenolate mofetil (MMF), and corticosteroids, with 43 receiving anti-CD25 monoclonal antibody induction. AR episodes were seen in 20 of 71 (28%) patients. Higher C2 levels at days 3 and 5 and the use of MMF were associated with a reduced incidence of AR, with increased HLA-DR mismatch associated with an increased risk for AR. C2 levels at days 3 and 5 below 885 and 1096 ng/mL, respectively, showed best discriminatory values for AR. C2 levels showed no correlation with DGF duration. This study suggests that optimizing immunosuppression in patients with DGF (by ensuring adequate calcineurin inhibitor exposure and the use of potent adjunctive immunosuppression) may reduce the incidence of AR without prolonging the duration of dialysis requirement.     

Lifeport灌注液中生物标志物与尸体供体肾移植术后移植肾功能延迟恢复的相关性分析

目的分析Lifeport灌注液中生物标志物与尸体供体肾移植术后移植肾功能延迟恢复(delayed graft function,DGF)的相关性,为临床决策提供理论依据。方法回顾性分析2019年6月1日—2019年8月31日期间西安交通大学第一附属医院43例DD肾脏应用Lifeport进行灌注维护的参数指标、灌注液生物标志物及实施肾移植的临床资料,对DGF的发生率及肾功能恢复时间等情况进行总结和分析。结果本研究的DGF发生率为18.6%(8/43),肾功能恢复时间为(11.7±10.6)d;DGF组肾功能恢复时间〔(30.8±22.7)d〕较NO-DGF组〔(6.8±7.0)d〕显著延长(P<0.001)。多因素logistic回归分析显示终末阻力(OR=1.879,95%CI=1.145~3.56)和灌注液标志物谷胱甘肽S-转移酶(glutathione S-transferase,GST)(OR=1.62,95%CI=1.23~2.46)是DGF的独立危险因素。比较GST联合终末阻力预测DGF的ROC曲线下面积(area under curve,AUC)与单独应用终末阻力预测DGF的AUC,预测准确性相较于单独应用终末阻力显著提高(P=0.023)。结论灌注参数(终末阻力)联合灌注液生物标志物(GST)可提高预测DGF的能力。     

尿液中性粒细胞明胶酶相关脂质运载蛋白和白细胞介素18水平检测在移植肾功能延迟恢复早期预测中的应用价值

目的 评价尿液中性粒细胞明胶酶相关脂质运载蛋白(NGAL)和白细胞介素18(IL-18)水平检测在早期预测移植肾功能延迟恢复(DGF)中的价值.方法 采用ELISA法,连续监测86例肾移植患者术前和术后12、24 h尿液标本中NGAL,IL-18及视黄醇结合蛋白(RBP)水平,并分析其与DGF的关系. 结果 86例中发生DGF 15例.术后12 h DGF组尿NGAL(ng/mg)水平明显高于非DGF组(1712.7±474.6比863.1±199.8,P<0.001),尿IL-18(ng/mg)水平与非DGF组比较差异无统计学意义(29.2±4.1比28.7±4.2,P>0.05);术后24 h DGF组尿NGAL和IL-18水平均明显高于非DGF组(分别为2905.0±1108.1比911.8±221.0,211.3±34.0比86.9±22.8,均P<0.001);而尿RBP(μg/mmol)(92.7±17.1比92.8±13.8,P>0.05)和SCr值(μmol/L)(608.1±85.5比542.3±99.6,P>0.05)与非DGF组比较差异无统计学意义.ROC曲线下面积分析结果显示,术后12 h尿NGAL曲线下面积为0.90,cut-off值为996.5 ng/mg时,诊断敏感性90.2%,特异性82.6%;术后24 h IL-18曲线下面积为0.76,cut-off值为148.5 ng/mg时,诊断敏感性76.3%,特异性66.4%. 结论 尿NGAL及IL-18水平变化对早期预测DGF发生有重要的临床意义.     

同种异体移植肾组织中B7蛋白的表达及其意义

目的观察同种异体移植肾组织中Ｂ７蛋白表达的特点，以期阐明其在急性细胞性排异中可能的致病作用。方法用ＰＡＰ免疫组织化学方法对急性细胞性排异（ＡＣＲ），无急性细胞性排异（Ｎ－ＡＣＲ）和正常对照肾组织中Ｂ７蛋白的表达进行观察，并结合肾间质中浸润淋巴细胞数和肾小管上ＨＬＡ－ＤＲ抗原的表达进行分析。结果ＡＣＲ组肾间质ＣＤ４＋，ＣＤ８＋和Ｂ细胞数较Ｎ－ＡＣＲ组和正常对照明显增高，与此相一致的是肾间质表达Ｂ７－１和Ｂ７－２的细胞也较Ｎ－ＡＣＲ组增高，但Ｂ７－２增加更明显。ＡＣＲ组肾小管上皮细胞ＨＬＡ－ＤＲ及Ｂ７－１的表达较Ｎ－ＡＣＲ组明显增高。结论肾小管上皮细胞有可能通过ＨＬＡ－ＤＲ和Ｂ７－１表达的上调作为抗原提呈细胞主动参与上述免疫反应的发生。     

High incidence of delayed graft function in HIV‐infected kidney transplant recipients

Kidney transplantation (KT) outcomes in human immunodeficiency virus (HIV)‐infected recipients are under continuous research. High incidence of early post‐transplant complications such as acute rejection has been observed. A multicenter study including HIV‐infected patients who underwent KT in Spain, from 2001 to 2011, was performed. The study population included 108 recipients, 36 HIV‐infected, and 72 matched HIV‐negative KT recipients. HIV‐infected recipients developed more delayed graft function (DGF) (52% vs. 21%, P < 0.001). One‐ and 3‐year graft survival was 91.6% and 86.2% in HIV‐infected patients, and 97.1% and 94.7% in HIV‐negative patients (P = 0.052). In two‐variate Cox analysis, HIV infection was not a predictor of graft loss after adjusting for time on dialysis, acute rejection, and DGF. Multivariate analysis for DGF revealed HIV‐positive status as independent risk factor. We analyzed the evolution of immunosuppressive and antiretroviral therapy (ART). In HIV‐infected patients tacrolimus trough levels were very high in the first week and significantly lower in the second week post‐transplant (P = 0.042). Post‐transplant ART was significantly changed: protease inhibitors use decreased (P = 0.034) and integrase inhibitor use increased (P < 0.001). DGF is another frequent early complication in HIV‐infected recipients that can affect graft survival. Strategies to prevent DGF and antiretroviral regimes with less drug interactions could improve outcomes.     

移植肾功能延迟恢复患者尿脱落细胞中穿孔素和粒酶B mRNA定量检测的意义

目的 探讨尿脱落细胞中穿孔素mRNA、粒酶B mRNA检测在移植肾功能延迟恢复(DGF)诊断中的应用价值. 方法 同种异体肾移植DGF患者24例.男15例,女9例.平均年龄37岁.移植肾活检病理分析病因为输尿管梗阻2例、静脉血栓1例、急性环孢素(CsA)中毒3例、急性肾小管坏死(ATN)7例、ATN合并临界改变2例、ATN合并急性排斥反应(AR)3例、AR 6例.移植术后1～14 d留取24例患者73份晨尿标本,应用竞争RT-PCR方法 对患者尿脱落细胞中穿孔素和粒酶B mRNA进行定量检测,应用SPSS13.0软件进行数据分析,mRNA水平用自然对数值表示.结果 24例患者尿脱落细胞中穿孔素和粒酶B mRNA水平在急性CsA中毒、ATN和其他组分别为(-0.76±0.35)、(-0.89±0.30)、(-0.90±0.15)fg/μg和(-0.53±0.22)、(-0.41±0.17)、(-0.73±0.23)fg/μg,组间厕两比较差异均无统计学意义(P>0.05);ATN合并AR组与单纯AR组分别为(1.20±0.39)、(11.13±0.33)fg/μg和(1.07±0.30)、(1.01±0.19)fg/μg,2组比较差异无统计学意义(P>0.05);ATN合并AR、单纯AR组与急性CsA中毒、ATN和其他组比较差异有统计学意义(P<0.001);2例ATN合并临界改变患者尿中穿孔素和粒酶B mRNA平均值分别为1.22、0.97 fg/μg,与ATN合并AR、单纯AR组相近. 结论 DGF患者尿脱落细胞中穿孔素和粒酶BmRNA水平检测有助于DGF的病因诊断,可作为临界改变是否需要进一步干预性治疗的指标之一.     

Acute rejection in kidney grafts with delayed onset of graft function

Forty-five kidney transplant recipients with delayed onset of diuresis due to acute tubular necrosis (ATN) were examined with duplex ultrasonography (DU). Resistive index (RI) was measured on the 4th post-transplant day. Eleven grafts (24%) developed acute rejection. Mean RI prior to rejection of the 4th postoperative day in these grafts was 0.97 and in the 34 grafts which did not develop rejection mean RI was 0.82. There were 2/26 rejections (8%) in the group of grafts with an initial RI below 0.9 and 9/19 rejections (47%) in the group of grafts with RI of 0.9 or above on the 4th post-transplant day. Six months postoperatively there were 2/26 nonfunctioning grafts in the group with lower initial RI values (<0.9) and 6/19 nonfunctioning grafts in the group with higher indices (0.9). In nonfunctioning grafts a high initial RI (0.9) indicates that these grafts will be prone to developing actute rejection.     

供肾零点活检病理结果与移植肾功能延迟恢复的相关研究

目的探讨供肾零点活检病理结果与肾移植术后并发移植肾功能延迟恢复(DGF)的关系。 方法回顾性分析西安交通大学第一附属医院肾移植科2018年5月至2019年4月实施的心脏死亡器官捐献(DCD)肾移植供、受者临床资料。采用零点活检病理结果评估供肾质量,并按照Banff 2013标准、Remuzzi评分及马里兰病理指数(MAPI)对供肾进行病理分级和评分。肾小球数量≥7个,小动脉数量≥2支为合格标本。根据受者肾移植术后是否发生DGF,将其分为DGF组和非DGF组。采用Mann-Whitney U检验比较两组供肾肾小球硬化率、小动脉玻璃样变率、Banff 2013标准评分、Remuzzi评分和MAPI评分。采用卡方检验比较两组供肾肾间质纤维化、肾小管萎缩、小动脉内膜纤维化增厚、小动脉管壁透明样变、肾小管损伤/坏死及肾小球内微血栓发生情况。采用logistic回归分析供肾零点活检病理结果与DCD肾移植术后并发DGF的关系。P<0.05为差异有统计学意义。 结果最终纳入133例受者,其中DGF组26例,DGF发生率为19.5%,非DGF组107例。133例合格肾穿刺标本中,平均获得肾小球数量(13±5)个,中位肾小球硬化率5.8%(0～13.3%),中位小动脉数量5支(3～6支),中位小动脉玻璃样变率0(0～11%),肾间质纤维化占47.4%(63/133),肾小管萎缩占48.1%(64/133),小动脉内膜纤维化增厚占58.6%(78/133),小动脉管壁透明样变占36.8%(49/133),未见肾小球内微血栓,所有供肾均合并不同程度肾小管损伤/坏死。两组受者供肾肾间质纤维化、肾小管萎缩、肾小管损伤/坏死以及Remuzzi评分差异有统计学意义(χ²＝7.65、7.92和16.81,Z＝-2.02,P均<0.05)。多因素分析结果显示肾小管损伤/坏死是肾移植术后并发DGF的独立危险因素。 结论供肾零点活检病理学评估对于预测肾移植短期预后具有一定价值,在供者维护和器官保存过程中应尽可能避免造成肾小管缺血/坏死,以降低DGF发生风险。     

ABO血型基因与移植肾急性排斥反应相关性的研究

目的 探讨ABO血型基因与移植肾急性排斥反应(AR)的相关性.方法 采用引物特异性聚合酶链式反应(PCR-SSP)技术检测2009年5月至2010年2月87例肾移植受者及其对应的48例供者ABO(A1、A2、B、O1、O2)血型基因,分析供受者ABO血型基因相合组与错配组受者AR发生、治疗及转归情况.结果 PCR-SSP测定ABO血型基因推定的表型和血清学方法测定ABO血型表型完全相符.供受者ABO血型基因相合组受者50例,发生AR 6例,经甲泼尼龙(MP)冲击治疗后临床逆转.ABO血型基因错配组受者37例,发生AR 11例,经MP冲击治疗后,临床逆转10例,周期性反复发生AR 1例.错配组与相合组受者AR发生率差异有统计学意义(29.7%与12.0%,P<0.05).错配组1例A2O1血型基因受者接受A1O1血型基因供肾后,受者血清检测发现抗A1抗体,抗体效价IgG 1:64,IgM 1:16,移植术后3～10个月周期性反复发生AR,且周期逐渐变短,激素疗效逐渐降低,术后1年SCr达441μmol/L.结论 检测供受者HLA时同步检测ABO血型基因具有很强的可行性.A2血型基因受者适宜选择O型供肾.供受者ABO血型基因错配是介导肾移植术后AR的危险因素,检测供受者ABO血型基因,降低ABO血型基因错配率对预防AR有一定的临床意义.     

持续低效每日透析治疗移植肾功能延迟恢复的临床效果

目的 探讨持续低效每日透析(sustained low-efficiency dai1y dialysis,SLEDD)治疗肾移植术后移植肾功能延迟恢复(delayed graft function,DGF)的疗效.方法 选择2011年6月至2016年3月西安交通大学第一附属医院肾移植科78例同种异体尸体肾移植术后发生DGF且需行肾脏替代治疗的患者.其中采用间断性血液透析(intermittent hemodialysis,IHD)治疗22例,采用SLEDD治疗32例,采用持续静脉-静液滤过(continuous veno-venous hemofiltration,CVVH)治疗24例,三组治疗前临床资料比较差异无统计学意义(P＞0.05).回顾性分析三种血液净化治疗模式对DGF患者尿毒症毒素浓度变化、血流动力学、水-电解质和酸碱平衡、疾病转归指标及所需血液净化时间、费用的影响.结果 三组患者每次治疗后尿毒症毒素平均浓度变化IHD组高于SLEDD及CVVH组(P＜0.01),血流动力学不稳定的发生率IHD组高于SLEDD及CVVH组(P＜0.05),每日液体出入量、超滤量SLEDD及CVVH组均较IHD组增多(P＜0.05),肾功能恢复率SLEDD及CVVH组优于IHD组(P＜0.05),移植肾功能恢复时间SLEDD及CVVH组明显短于IHD组(P＜0.05),SLEDD与CVVH组比较差异无统计学意义(P＞0.05).电解质及酸碱平衡指标三组间差异无统计学意义(P＞0.05);血液净化治疗费用CVVH组明显高于IHD及SLEDD组(P＜0.05),IHD组与SLEDD组无明显差别(P＞0.05).结论 SLEDD在DGF治疗中,与IHD比较,患者血流动力学相对稳定,移植肾功能恢复率高、恢复时间短,并有相对较大的液体摄入空间;与CVVH比较,尿毒症毒素浓度变化、血流动力学、移植肾功能恢复率及恢复时间无明显差异,但血液净化治疗所需时间及费用相对较少.     

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。