肾移植术后早期长时间无尿的原因及处理

肾移植术后早期长时间无尿是指肾移植术后３ｄ以内即出现无尿并持续３周以上。我院自１９７９年１０月～１９９６年８月共行尸体肾移植术５９４例（６４０次）,其中术后早期长时间无尿３１例,发生率为４．８％。现报告如下。１　临床资料本组３１例,男２１例,女１０例,年龄２５～６２岁,平均３８．２岁。原发病为慢性肾炎尿毒症２９例,糖尿病肾病尿毒症２例。尿毒症病程２５ｄ～２年３个月。入院时尿素氮１６．２～２８．６ｍｍｏｌ／Ｌ,肌酐９８６～１６２０μｍｏｌ／Ｌ,５例乙型肝炎表面抗原＋,６例心脏明显扩大伴心包积液,２…     

肾移植术后91例死亡原因回顾性分析

肾移植术后９１例死亡原因回顾性分析马麟麟，吴国荃１９８３年１月～１９９２年１２月，我院５９２名肾移植受者中死亡９１例，死亡率１５．４％。现对死亡原因做一回顾性分析。材料与方法本组５９２例肾移植受者中，男４１５例，女１７７例；年龄１４～６６岁，平均３５...     

肾移植术后恶性肿瘤47例分析

目的 了解恶性肿瘤在肾移植患者中的发病率，并探讨其发病率增高的机理。方法 回顾性分析1978-2000年6月间接受免疫抑制治疗（至少半年）的肾移植患者中发生恶性肿瘤的病例。结果 在1120例肾移植患者中，发生恶性肿瘤47例，其中40例资料完整，34例得到病理证实。恶性肿瘤发病率为4.2%。肿瘤治疗以手术治疗为主。辅以化疗和放疗，免疫治疗，有25例至今存活，最长存活期达4年半。结论 肾移植患者恶性肿瘤发生率明显高于一般人群。其机理除了应用免疫抑制治疗所带来的后果外，也不能忽视移植术本身带来的影响。如癌基因嵌合，致癌病毒的转移等。     

肾移植术后恶性肿瘤12例分析

目的　探讨肾移植后肿瘤的发病情况和防治措施。方法　回顾性分析 931例 10 15次肾移植的临床资料。结果　共发生恶性肿瘤 12例 ,发生率 1.2 8% ,于移植术后 (45 .9± 36 .8)个月 (12～ 12 4个月 )得到明确诊断 ,其中泌尿系统肿瘤 5例 ,硬脑膜小细胞癌、胰头癌、胃腺癌、肝癌、肺门鳞癌及滤泡状淋巴瘤各l例 ,另有 1例原发瘤不明的转移性肝癌。 6例获手术治疗 ,存活 (11.0± 8.8)个月 ,现仍存活 ;5例于诊断后 (4.4± 2 .7)个月死亡。结论　肾移植患者的肿瘤发生率明显增高 ,以泌尿系统的肿瘤多见 ,治疗上应尽早采取以手术为中心的综合治疗     

肾移植术后6例尿瘘原因分析

本组报告1998年9月--1999年9月78例肾移植术后,6例发生尿瘘的临床资料,其发生率为7．6％,探讨其发生的原因,临床处理与预后的关系。     

肾移植术后肝功能异常的原因和治疗

肝功能损害是肾移植术后常见的合并症,是影响肾移植患者预后的一个重要因素。为探讨肾移植术后肝功能损害的原因,提高肾移植术后肝功能异常的治疗效果,现对在我院进行肾移植手术并长期随访的130例患者的临床资料进行回顾性分析,报告如下。     

肾移植术后特异性感染69例次分析

目的 探索肾移植术后感染发生的规律。方法 回顾分析我院８０８例次肾移植中各种感染的临床资料。结果 ８０８例次肾移植中发生各种感染１８０例次（２０．７％）,死亡３５例（１９．４％）,其中应用硫唑嘌呤和泼尼松者的感染发生率及死亡率较使用以环孢素Ａ为主的三联疗法者为高。已证实感染原的特异性感染６９例次。特异性感染的病原最常见者为病毒。结论 感染是肾移植后的常见并发症,正确调整免疫抑制剂剂量,及时病原诊断     

肾移植术后巨细胞病毒感染

巨细胞病毒(ＣＭＶ)感染是肾移植术后的一种常见并发症,据报道ＣＭＶ活动性感染率在肾移植受者中约50%～75%,有10%～30%的患者为有症状的ＣＭＶ感染。供者血清学ＣＭＶＩｇＧ阳性,受者阴性,是ＣＭＶ感染的高危人群,术后感染率高达96%。轻度感染者一般为自限性疾病,症状多数在1～3周内自行消失。一旦发生严重的ＣＭＶ感染,特别是肺间质性炎症,死亡率高达25%。一、ＣＭＶ和ＣＭＶ感染ＣＭＶ是人类疱诊病毒之一。它有复杂的双链ＤＮＡ螺旋核心,因病毒侵入细胞内,外面包裹有宿主胞核膜,或内质网形成的脂质层包壳,直径约180ｎｍ。病毒基因包含重…     

肾移植术后尿瘘19例临床分析

尿瘘是肾移植术后较为常见的外科并发症,但许多移植医生对此尚未引起足够的重视,引起不良后果。我院自1995年20月至2001年1月共施行肾移植236余例,术后1～7日发生尿瘘19例,发生率8.05％,现总结分析如下。 临床资料 本组19例尿瘘患者男性11例,女性8例,年龄28～63岁,平均46岁。首次移植17例,第三次移植2例;其中17例首次移植采用输尿管与膀胱壁的外隧道式吻合,2例第三次移植采用移植肾输尿管与原移植肾输尿管残端的端-端吻合。术前患者每日尿量<100ml 6例、每日尿量600～1000ml 13例,尿瘘发生于手木后1～7日。     

肾移植术后继发性甲状旁腺功能亢进的临床分析

目的研究肾移植术后合并甲状旁腺功能亢进的受者血清钙、磷代谢及免疫反应性甲状旁腺激素(iPTH)水平的变化趋势,探讨治疗方式的选择。 方法回顾性分析2012年1月至2014年6月在解放军第三〇九医院全军器官移植研究所泌尿外科因尿毒症行肾移植、且术前并发继发性甲状旁腺功能亢进(SHPT)、术后移植肾功能恢复至估算肾小球滤过率(eGFR)>60 mL·min^－1·(1.73 m²)^－1的受者资料。共179例受者纳入研究,平均年龄(34±6)岁(18～61岁),术前慢性肾脏病分级均为5级。肾移植术后常规应用骨化三醇治疗(0.25 μg,1次/d),维持正常血清钙、磷水平。记录肾移植前后受者血清钙、磷及iPTH水平。采用单因素重复测量资料方差分析比较肾移植前和移植后1周、1个月、6个月、12个月和24个月受者血清钙、磷、iPTH水平,采用χ²检验比较低磷血症和高钙血症发生率以及iPTH分布情况。 结果肾移植术后1个月受者血清钙上升至稳定期,同时血清磷下降至稳定期;术后6个月高钙血症和低磷血症发生率最高,分别为8.4%(15/179)和9.5%(17/179)。术后1～6个月受者iPTH下降明显,随后无明显变化,术后24个月仅有27%(48/179)的受者iPTH水平降至完全正常。 结论尿毒症患者行肾移植术后,SHPT均有所缓解,但大部分无法恢复至正常水平,术后需要进行积极的针对性治疗。     

肾移植后重症肺炎38例临床分析

目的 分析总结38例肾移植术后肺炎重症患者临床特点及救治措施.方法 选择38例2006年至2011年在郑州大学第一附属医院呼吸暨重症监护室收治的肾移植术后肺部感染患者的临床资料进行回顾性分析.结果 38例患者治愈30例,死亡8例.结论 肺炎肾移植患者应用免疫抑制剂的严重并发症,全面综合治疗是救治成功的关键.     

肝移植术后早期急性肾功能衰竭5例临床分析

目的总结肝移植术后早期急性肾功能衰竭的防治经验。方法回顾性分析5例肝移植受者术后早期发生急性肾功能衰竭临床资料,手术方式为改良背驮式肝移植术,其中4例术前即合并肾功能不全。结果5例术后早期急性肾功能衰竭患者3例通过调整免疫抑制方案和改善肾脏灌注及利尿治疗肾功能恢复;2例给予连续性肾脏替代治疗后肾功能恢复。结论肝移植术后免疫抑制剂的个体化应用,积极改善肾脏灌注,必要时选择血液透析治疗,有助于防治肝移植术后早期急性肾功能衰竭。     

右美托咪定对异体肾移植患者围术期肾功能的影响

目的研究右美托咪定对同种异体肾移植患者围术期肾功能的影响。方法选择行同种异体肾移植患者60例,男36例,女24例,年龄25~45岁,ASAⅡ或Ⅲ级,随机分为两组:右美托咪定组和对照组,每组30例。右美托咪定组麻醉诱导前给予右美托咪定1μg/kg泵注10min,随后以0.6μg·kg~(-1)·h~(-1)维持泵注至手术结束前30min;对照组以等容量生理盐水维持至手术结束前30min。记录两组患者在麻醉诱导前(T_1)、吻合血管开放前(T_2)、吻合血管开放后即刻(T_3)、吻合血管开放后30min(T_4)和手术结束后(T_5)的HR和SBP,于T_2、T_4、术后24h(T6)及术后48h(T7)采取静脉血检测血尿素氮(BUN)、血肌酐(Cr)、IL~(-1)8和半胱氨酸蛋白酶抑制剂C(Cys C)的浓度;记录术中液体输注量和尿量。结果 T_3时右美托咪定组HR明显慢于对照组;T_2、T_3时右美托咪定组SBP明显高于对照组(P0.05)。与T_2时比较,T6、T7时两组Cys C、BUN、Cr浓度明显降低,且T7时右美托咪定组Cys C浓度明显低于对照组(P0.05)。与T_2时比较,T6、T7时两组IL~(-1)8浓度明显降低,且右美托咪定组降低幅度明显大于对照组(P0.05)。右美托咪定组围术期尿量明显多于对照组(P0.05)。两组术中液体输注量差异无统计学意义。结论围术期应用右美托咪定可有效保护肾移植患者的肾功能。     

Multiple drug combinations with "low-dose" cyclosporin for renal transplantation: Multivariate analysis of risk factors determining short-term graft survival within one renal transplant center

Abstract. The factors affecting graft survival in transplant recipients receiving cyclosporin (CsA) are still being debated. Our report is based on an analysis of 202 successive transplantations performed in our institution from May 1984 to December 1986, using low-dose CsA as the basic means of immunosuppression. A total of 142 patients received the triple combination CsA, azathioprine (AZA), and corticosteroids. Sixty patients received a prophylactic combination of CsA, corticosteroids, and antilymphocyte globulins (ALG). From January to December 1986, both regimens were compared in a prospective randomized trial. The factors that affect graft survival were analyzed using the Cox multivariate hazard analysis. The relative risks were calculated for pre-transplant baseline risk factors and for outcome-dependent post-transplant risk factors for surviving grafts at 1 month. Transplants performed with a prolonged ischemia time and patients whose graft did not function immediately were statistically at higher risk of graft loss. Adding prophylactic ALG to CsA was associated with better graft survival. Patients who experienced more than 1 rejection crisis and patients whose 1-month CsA dose was lower than or equal to 5 mg/kg per day were also at significantly higher risk of further graft loss. Neither HLA matching, peak panel reactivity, age of the recipient, occurrence of post-transplant renal dysfunction nor 1-month renal function affected the short-term graft outcome.     

经典非转流原位肝移植术后早期肾功能障碍的原因分析

目的观察经典非转流原位肝移植（orthotopic liver transplantation,OLT）术后早期肾功能障碍（renal dysfunction,RD）发生的原因并提供临床参考.方法前瞻性研究了连续48例经典非转流OLT病例,根据术后早期（术后第1周）血清肌酐水平进行分组.对单因素分析后有显著性差异的资料进行多因素回归分析.结果经典非转流OLT术后早期RD的发生率为35.4%.Binary Logistic多元回归分析显示：术前RD、Child-Pugh评分、无肝期门静脉开放后1 h尿量是该术后早期RD的危险因素.结论对于术前明显肾功能障碍或Child-Pugh评分较高的病人,应避免使用经典非转流术式.对于接受经典非转流手术的病人,术前应纠正肾功能异常;术中应避免血流动力学的剧烈波动,保持稳定有效的肾血流灌注,以减少术后早期RD的发生.     

Costs of drugs used after renal transplantation

Abstract  There are no detailed data on the relative contributions to overall health care costs of the various drugs that are commonly used in renal transplant patients. We per formed a cost analysis in 122 patients, using the medical records and our hospital administration service as data sources, for all health care-related costs during the first year after renal transplantation. During the first 3 months all patients were on cyclosporine (CsA) and prednisone. Subsequently, they were randomly allocated to CsA monotherapy or to conversion from CsA to azathio-prine. Cost of drugs comprised about 25 % of total health care expenses. In CsA-treated patients, the following costs per patient per year were calculated: CsA, DFL 9929 (1 DFL is about US $ 0.60; 67.5 % of total drug costs); antilymphocyte agents, DFL 2613 (17.8 %); other immunosuppressive drugs, DFL 455 (3.1 %); antimicrobial agents, DFL 657 (4.7 %); antihypertensive drugs, DFL 467 (3.2 %); remaining drugs, DFL 554 (3.8 %). Conversion from CsA to azathioprine resulted in a decrease in mean drug costs for the remainder of the first posttransplant year of DFL 4597 ( P < 0.01). Al though the incidence of acute rejections tended to be higher after ste roid withdrawal than after conversion (39 % versus 26 %, not significant), the costs of anti-rejection therapy, hospitalization, and laboratory services did not differ. We conclude that CsA is the main determinant of overall drug costs. When compared to CsA monotherapy, conversion from CsA to azathio prine at 3 months after transplantation may result in subsequent cost savings of about DFL 5000 per patient per year without a higher incidence of rejection or graft loss.     

Improved outcome of renal transplantation in amyloidosis

Abstract We report our results in 96 patients with amyloidosis who received 105 cadaveric renal allografts. The graft survival of amyloidosis patients has improved with time and with improved immunosuppression. The graft survival of amyloidosis patients is comparable to the results in another systemic disease, i.e., diabetes,     

Causes of frequency and nocturia after renal transplantation

OBJECTIVE

To explore the role of bladder capacity, bladder pain, dysfunctional voiding, urgency, urinary tract infections (UTIs), and urinary output as potential causes of frequency and nocturia after renal transplantation.

PATIENTS AND METHODS

Data were gathered from 52 adult renal transplant patients (35 men and 17 women, mean age 49 years), using a written questionnaire, medical records, frequency/volume charts, and urinary cultures. The mean time between transplantation and data collection was 5 months. Structural equation modelling (SEM) was used for the simultaneous assessment of direct and indirect relationships between explanatory variables and voiding frequency.

RESULTS

Frequency and nocturia were found in 54% and 60% of the study population, respectively. Frequency was directly associated with a small bladder capacity, bladder pain, urgency, and a high daytime urine volume, and indirectly by UTIs (via urgency and bladder pain). Nocturia was associated with high nocturnal urine volume, small bladder capacity and dysfunctional voiding. A quarter of the patients had small bladders and another quarter had large bladders, the latter being associated with nocturnal polyuria.

CONCLUSIONS

The presence of frequency, especially when accompanied by bladder pain, might aid the physician to identify patients with small bladders. The presence of nocturia can be the result of a high nocturnal urine volume, which increases the risk of bladder enlargement. Because both abnormal bladder conditions can contribute to graft dysfunction, we recommend a urological follow‐up after renal transplantation, using frequency/volume charts.     

Hypertension following renal transplantation in children

The files of 334 consecutive cadaver kidney (CK) and of 27 living related (LR) transplantations (T) in children and adolescents performed from 1973 to 1984 have been reviewed. Following cadaver transplantation, 52 patients (15%) never had hypertension (HT), 41 patients (12%) had only initial HT up to 6 months after transplantation and 18 other patients (5%) exhibited transient HT episodes while on high-dose steroid therapy. Finally, 209 patients (62%) had HT for periods longer than 6 months and 16 patients (5%) until death or graft failure within the first 3 months. Chronic graft rejection was the major cause of HT, but other factors either isolated or in association were also present. Renal artery stenosis (RAS) was diagnosed in 43 cases (13%) 2–17 months post-transplantation; 10 of these were operated upon (5 successfully) and 9 underwent transluminal angioplasty with a single success. Nine cases of RAS resolved spontaneously. HT was attributed to the host kidney in 10 cases (3%) and to recurrence of primary renal disease in 9 (3%). HT observed after CKT was sometimes severe and difficult to control. Acute complications from HT were recorded in 35 cases, with 6 deaths and 2 severe neurological sequelae. Among 25 LRT, 11 cases (40%) had no HT 13 (48%) had HT for longer than 6 months. In this group, no case of RAS was observed and only one complication (without sequelae) was noted. In conclusion, HT is a frequent and sometimes severe complication post-transplantation in children and adolescents.