187例肾移植受者死亡原因分析

目的分析肾移植受者的死亡原因。方法回顾性分析1978年至2003年期间进行同种肾移植的1400例受者资料。对肾移植后受者的死亡率、死亡原因和时间进行分析。结果1400例肾移植受者中,共死亡187例,死亡率为13.36%。187例受者的死亡原因依次为感染、心脑血管疾病和肝功能衰竭;所占比率分别为37.97%、31.56%和14.97%。死亡的受者中,移植肾有功能的87例,占46.5%。结论感染、心脑血管疾病及肝功能衰竭是肾移植后受者死亡的主要原因。将近一半的受者死亡时移植肾有功能。     

肾移植受者移植肾带功能死亡与失功能死亡原因比较

目的 分析肾移植受者移植肾带功能死亡与失功能死亡原因.方法 回顾分析我院2001年至2010年期间死亡的207例肾移植受者资料.将其分为移植肾带功能死亡组(102例)和失功能死亡组(105例),对两组死亡原因进行比较分析.结果 所有受者的死亡原因依次为感染(31.9％)、心血管疾病(21.3％)、肝功能衰竭(15.9％...     

肾移植受者术后发生恶性肿瘤的危险因素和预后分析

目的 分析肾移植受者术后发生恶性肿瘤的情况.并探讨发生恶性肿瘤的危险因素和预后.方法 回顾性分析1991年1月至2007年8月间2392例肾移植受者中术后恶性肿瘤的发生率、恶性肿瘤的类型、移植时年龄、术后至肿瘤诊断的时间、免疫抑制剂应用情况及预后等资料;比较免疫诱导组与非免疫诱导组的一般情况;并进行发生肿瘤危险因素的相关性分析.结果 31例肾移植受者术后发生恶性肿瘤,发生率为1.29%.恶性肿瘤发生率与肾移植时年龄和免疫诱导治疗呈正相关.免疫诱导组在恶性肿瘤诊断时肾功能不全发生率较非免疫诱导组明显降低,但肾移植术后至恶性肿瘤诊断时的时间明显缩短,且患者术后1年存活率无明显改善.88.7%的患者于诊断后24个月内死亡.结论 肾移植时的年龄和免疫诱导是发生恶性肿瘤的危险因素.肾移植术后发生恶性肿瘤的患者预后差.     

乙型肝炎病毒和丙型肝炎病毒感染对肾移植受者存活的影响

目的探讨乙型肝炎病毒(HBV)和(或)丙型肝炎病毒(hepatitis C virus,HCV)感染对肾移植受者长期存活的影响及预防措施。方法 HBV和(或)HCV感染肾移植受者110例(感染组),其中HBV感染受者56例、HCV感染受者52例,HBV与HCV合并感染2例。非HBV与非HCV感染受者694例(非感染组)。感染组受者术前有病毒复制者予积极治疗,研究早期肝功能正常者可接受肾移植,后期均用聚合酶链反应(PCR)检测,要求连续3～6个月HBV脱氧核糖核酸(DNA)0copy/ml,HCV核糖核酸(RNA)0copy/ml方可接受肾移植。术后定期检测HBV与HCV,定期检测感染组受者HBVDNA滴度、HCVRNA滴度。发现HBV复制,选用拉米夫定、阿德福韦酯治疗,酌情减少免疫抑制剂用量。分别比较两组术后1、3、5年人、肾存活率,比较两组的肝功能衰竭病死率。结果非感染组人、肾存活率分别为:1年94.2%、91.4%,3年为86.4%、85.2%,5年为82.7%、78.9%;感染组人、肾存活率分别为:1年90.2%、88.1%,3年为88.9%、86.2%,5年为81.5%、76.3%;两组数据比较差异均无统计学意义(均为P>0.05)。感染组中14例(12.7%)死于肝功能衰竭,其中10例为HBV感染者,非感染组受者无1例死于肝衰竭。感染组术后肝衰竭病死率明显高于非感染组(12.7%、0,P<0.05)。结论受者术前HBV和(或)HCV感染会明显增加肾移植术后肝衰竭死亡危险。患者术前处于病毒复制期应予积极治疗,在肝炎病毒停止复制6个月后再考虑肾移植。长期随访中应定期复查HBV与HCV感染指标,早确诊、早治疗,并及时调整免疫抑制剂剂量。     

肾移植后并发恶性肿瘤的临床分析

目的 :探讨肾移植受者恶性肿瘤的发病情况、类型及治疗措施。方法 :回顾性分析我院 1 992～ 2 0 0 0年 2 0 3例肾移植受者术后肿瘤的发生情况。结果 :发生恶性肿瘤 6例 ,发生率为 2 .95 % ,其中消化道肿瘤 4例 ,皮肤Kaposi肉瘤 2例。 3例行手术治疗 ,1例Kaposi肉瘤自行消退 ,现已生存 (1 9.5± 1 4 .1 )个月 ,另 2例属肿瘤晚期 ,于短期内死亡。结论 :肾移植术后恶性肿瘤的发生及种类 ,因种族、地域和饮食习惯的差异而有所不同 ,治疗上应争取尽早手术切除肿瘤 ,并大幅度减低免疫抑制剂剂量     

器官移植后的个体化免疫抑制治疗

由于手术技术的提高,对移植免疫学认识的加深以及强有力免疫抑制剂的问世,器官移植近期效果明显提高.以同种肾移植为例,移植物1年存活率已高达90%以上,但远期效果并未同步提高.为此,更高的长期存活率和更好的生活质量是我们追求的目标.肾移植1年以后,移植肾功能丧失的原因中,受者带肾功能死亡和慢性移植肾功能异常各占50%.心血管疾病、感染和肿瘤是受者带肾功能死亡的最常见原因.感染和肿瘤与免疫抑制过度有关,而心血管疾病也与免疫抑制药物所致之代谢异常相关.     

肾癌的外科诊治现状

现就近 10年来肾癌的发病率、病理分类、诊断及外科治疗等方面的进展综述如下。一、流行病学美国统计资料显示从 195 0年起 ,肾恶性肿瘤的发病率和死亡率呈逐年上升趋势 ,至 2 0 0 1年发病率上升了 12 6 % ,死亡率上升了 36 .5 % [1] ,而 5年生存率仅提高了 9%左右[2 ] 。Jemal等[3 ] 报道 :估计 2 0 0 3年美国肾恶性肿瘤新病例数3190 0人 ,占全身恶性肿瘤的 2 .39% ,死亡 1190 0人 ,占全身恶性肿瘤的 2 .14 % ;其中男性新病例数 195 0 0人 ,女性12 4 0 0人 ,男女新患病人数比例为 1.6∶1.0。据 1990～ 1992年我国 2 2省 (市、自治区 )抽样…     

重视肾移植术后肺部感染的诊治

1概述 目前,尽管在组织配型、移植外科技术及免疫抑制剂的开发、应用等方面取得重大进展,但感染和排斥反应仍然是导致肾移植受者发病和死亡的主要原因,并且感染和排斥反应密切联系相关,直接影响到人肾的长期存活,成为肾移植术后对受者及移植肾长期存活最大的威胁.据国际多个移植中心的统计,肾移植后第1年约有75％的受者发生过各种不同程度的感染,26％的患者直接死亡原因是感染[1].其中肺部感染是肾移植术后最常见的感染,也是肾移植受者最主要的死亡原因之一.肾移植术后肺部感染的特点是起病急、进展快、早期即可出现低氧血症,如进展至ARDS,死亡率可高达50％以上[2].因此采取有效措施进行肺部感染的早期诊治成为企待解决的问题.     

肾移植受者肾结石的诊治分析

根据近年文献报道,肾移植受者的泌尿系结石发病率为0.2%～1.7%[1-2],而普通人群的发病率约2%～3%,二者发病率十分接近.回顾性分析我院2000余例肾移植受者的临床资料,其中术后发现移植肾结石9例,占肾移植受者的0.45%.本文将这些移植肾结石的诊断、治疗体会报告如下.     

肾移植受者皮肤、粘膜恶性肿瘤研究进展

肾移植受者移植后恶性肿瘤危险率达80%.在免疫功能受到抑制时,皮肤和粘膜易患恶性肿瘤.在肾移植受者的皮肤、粘膜恶性肿瘤中发现非常高的人乳头瘤病毒(HPV)感染,致癌高危亚型HPV16、18更常见于肾移植受者的女性生殖道.HPV是一种易侵犯皮肤和粘膜的肿瘤病毒,是皮肤、粘膜恶性肿瘤发生发展的重要因素.充分认识和积极干预将减少肾移植受者移植后的常见合并症-皮肤、粘膜恶性肿瘤的发病率和死亡率,有助于提高患者生活质量、延长寿命.     

乙、丙型肝炎病毒感染对肾移植患者长期存活的影响

目的　了解乙型肝炎病毒（ＨＢＶ） 及丙型肝炎病毒（ＨＣＶ） 感染对肾移植患者长期存活的影响。方法　对８０ 例感染ＨＢＶ、ＨＣＶ 者肾移植术后肝病及排斥的发生情况、死亡原因及长期存活率进行分析。结果　移植后慢性肝病发生率为２１ ．２５％ , 死亡率为１８ ．７５ ％ , 显著高于非感染组（１ ．１９ ％ , Ｐ＜ ０．０１） ;ＨＣＶ 组超急性排斥及加速性排斥的发生率（６ ．０６％ ,９ ．０９ ％ ） 显著高于非感染组（０ ．７２ ％ ,２ ．７４ ％ ; Ｐ＜ ０ ．０１ , Ｐ＜ ０ ．０５）。结论　ＨＢＶ及ＨＣＶ感染显著影响肾移植受者的长期存活率; 移植后肝病及感染是其主要死因; 对ＨＢＶ 及ＨＣＶ 感染患者应采取合理的免疫抑制治疗。     

Infection-related mortality in a large cohort of renal transplant recipients

INTRODUCTION: Infections represent a major cause of morbidity and mortality among renal transplant recipients. Our aim was to analyze the incidence and etiology of infection-related mortality among a large cohort of renal transplant recipients. METHODS: From 1995 to 2004, we collected all causes of mortality among patients receiving a renal transplantation. The date of transplant, the last follow-up/death, type of transplant, age, and cause of death were tabulated into a database. The incidence rate of mortality was calculated in events per 10,000 transplant months. RESULTS: Among the 1218 renal transplants performed in the study period the causes of mortality were: cardiovascular, 65 (38%); infection, 49 (29%); cancer, 21 (12%); other causes, 18 (10.5%); and unknown, 18 (10.5%). Infection-related mortality were: sepsis = 17 (35%), bacterial pneumonia = 9 (18%), abdominal bacterial infection = 2 (4%), invasive viral infection = 12 (24%), and invasive fungal infection = 9 (18%). There were no differences in the global causes of mortality according to the year of transplantation. The incidence rate of infection-related mortality was higher among aged patients and similar to cardiovascular-related mortality. Comparing the periods 1995 to 1999 with 2000 to 2004, bacterial infection-related mortality remained stable (57% vs 57%), while viral infection-related mortality decreased (31% vs 7%) and fungal infection-related mortality increased (11% vs 36%; P = .06). CONCLUSIONS: In the last decade, infection-related mortality among renal transplant recipients has not decreased. Although better control of invasive viral infections has been achieved, bacterial and fungal invasive infections remain important causes of mortality in this population.     

Evolution of Causes and Risk Factors for Mortality Post‐Liver Transplant: Results of the NIDDK Long‐Term Follow‐Up Study

Although mortality rates following liver transplantation (LT) are well described, there is a lack of detailed, prospective studies determining patterns of and risk factors for long‐term mortality. We analyzed the multicenter, prospectively obtained The National Institute of Diabetes and Digestive and Kidney Diseases LT Database of 798 transplant recipients from 1990 to 1994 (follow‐up 2003). Overall, 327 recipients died. Causes of death >1 year: 28% hepatic, 22% malignancy, 11% cardiovascular, 9% infection, 6% renal failure. Renal‐related death increased dramatically over time. Risk factors for death >1 year (univariate): male gender, age/decade, pre‐LT diabetes, post‐LT diabetes, post‐LT hypertension, post‐LT renal insufficiency, retransplantation >1 year, pre‐LT malignancy, alcoholic disease (ALD) and metabolic liver disease, with similar risks noted for death >5 years. Hepatitis C, retransplantation, post‐LT diabetes, hypertension and renal insufficiency were significant risk factors for liver‐related death. Cardiac deaths associated with age, male gender, ALD, cryptogenic disease, pre‐LT hypertension and post‐LT renal insufficiency. In summary, the leading causes of late deaths after transplant were graft failure, malignancy, cardiovascular disease and renal failure. Older age, diabetes and renal insufficiency identified patients at highest risk of poor survival overall. Diligent management of modifiable post‐LT factors including diabetes, hypertension and renal insufficiency may impact long‐term mortality.     

Urinary creatinine excretion reflecting muscle mass is a predictor of mortality and graft loss in renal transplant recipients

BACKGROUND: Insulin resistance has been implicated to underlie both excess cardiovascular disease and chronic transplant dysfunction after renal transplantation. Skeletal muscle mainly determines peripheral insulin resistance, and could therefore affect outcome. METHODS: All transplant recipients at our outpatient clinic with a functioning graft more than 1 year were invited to participate between 2001 and 2003. Mortality and death censored graft loss were recorded until August 2007. We used 24 hr urine creatinine excretion as measure of muscle mass. Cox regression was used to analyze the prospective data. RESULTS: Six hundred four renal transplant recipients (age 51+/-12 years, 55% men) were studied. Creatinine excretion was 10.1+/-2.6 mmol/24 hr in women and 13.6+/-3.4 mmol/24 hr in men. During follow-up of 5.3 (4.7-5.7) years, 95 recipients died and 42 suffered graft loss. Determinants of creatinine excretion were weight, sex, age, height, cumulative prednisolone doses, and diabetes (r2=0.45). Creatinine excretion was associated with both mortality (3rd vs. 1st tertile Hazard ratio: 0.4 [95% confidence interval 0.2-0.7], P=0.003) and graft loss (3rd vs. 1st tertile Hazard ratio: 0.4 [95% confidence interval 0.1-0.9], P=0.03) independent of age, sex, serum creatinine, proteinuria, insulin resistance related factors, time after transplantation, and duration of dialysis. CONCLUSIONS: Creatinine excretion as measure of muscle mass is associated with mortality and graft loss after renal transplantation, independent of insulin resistance and its related factors. We speculate that preservation of muscle mass by stimulating exercise, sufficient diet, and less use of corticosteroids may be relevant for improving prognosis in renal transplant recipients.     

肾移植176例死亡分析

目的：分析探讨肾移植受者的死亡情况和死亡在因。方法：总结1977年10月至1999年6月1039例尸体肾移植患者的临床资料。术后患者死亡率的计算按Kaplan-Meier乘积极限法进行。对可能影响移植受者死亡的因素，加供受者性别和年龄、移植次数、移植前透析时间、移植前输血量、淋巴细胞毒交叉试验、冷缺血时间、肾功能延迟恢复、急慢性排斥反应、免疫抑制药物治疗以及术后并发症等因素进行log-rank单因素和Cox模型多因素分析。结果：截至1999年12月，1039例中存活863例，死亡176例。总的术后1、5、10及15年累计死亡率分别为6．9％、19．7％、32．1％和34．7％，感染、心脑血管疾病和肝功能衰竭分别占38．1％、21．6％和14．8％。在全部死亡病例中，移植肾有功能者占75．0％，而移植后1年以上的死亡患者中移植物有功能者占87．5％。对可能影响患者死亡的诸多变量进行单因素和多因素的综合分析显示：移植年代、移植前透析时间、免疫抑制药物治疗、慢性排斥反应、术后肺炎以及心脑血管疾病并发症等6个因素与肾移植术后患者的死亡相关（P＜0．001）。结论：移植1年后患者死亡率以平均每年2．5％的速度递增。感染、心脑血管疾病和肝功能衰竭是引起死亡的3个主要原因。接受移植的年代、移植前透析时间、免疫抑制药物治疗、慢性排斥反应、术后肺炎以及心脑血管疾病并发症等是肾移植受者死亡的重要影响因素。     

The burden of acute renal failure in nonrenal solid organ transplantation

BACKGROUND: Recipients of nonrenal solid organ transplants are at risk for acute renal failure resulting from cardiac or hepatic failure, prolonged surgery, and nephrotoxic effects of immunosuppression. Single-center studies have suggested a variable incidence of acute renal failure in this population, with an associated increase in mortality. This study examines the incidence of acute renal failure and its associated mortality and morbidity in a modern multicenter cohort. METHODS: All adult liver, heart, and lung transplant recipients from 2002 were identified from the New York Statewide Planning and Research Cooperative System database. The impact of acute renal failure on mortality, length of stay, and charges was analyzed using multivariate regression models. RESULTS: Among 519 liver, heart, and lung transplant recipients, the incidence of acute renal failure was 25%, with 8% of patients requiring renal replacement therapy. Acute renal failure requiring renal replacement therapy was associated with increased mortality among both heart (odds ratio, 9.0; 95% confidence interval, 1.8-45.8) and liver transplant recipients (odds ratio, 12.1; 95% confidence interval, 3.9-37.3). This degree of acute renal failure also increased length of stay by nearly 3 weeks and charges by more than $115,000. Even among patients who did not require renal replacement, acute renal failure was strongly associated with increased mortality, length of stay, and charges. CONCLUSIONS: Acute renal failure remains a common complication of nonrenal solid organ transplantation and is associated with increased mortality, prolonged hospitalization, and significant financial costs.     

Death within the first year after kidney transplantation – an observational cohort study

The risk of death within the first year postkidney transplantation is not well described in the contemporary era. We extracted data on all kidney transplant procedures performed in England between April 2001 and March 2012. Data linkage analysis was performed between Hospital Episode Statistics and the Office for National Statistics to identify all deaths. Cox proportional hazard models were performed to identify factors associated with 1‐year mortality. 566 deaths (3.0%) occurred within the first year post‐transplant (from 19 103 kidney transplant procedures analysed). Infection, cardiovascular events and malignancy were classified in 21.6%, 18.3% and 7.4% of death certificates, respectively. Among recipients with prior myocardial infarct history who died within the first year, 38.8% of deaths were attributed to a cardiac‐related event. Malignancy‐related death was responsible for 61.5% of 1‐year mortality for allograft recipients with pretransplant cancer history. 22.1% of deaths included kidney failure as a contributory factor on the death certificate (3.3% specifically stated allograft failure). Variables associated with 1‐year mortality included deceased‐donor kidney, increasing age, residence in socioeconomically deprived area and history of select medical comorbidities pre‐operatively. We conclude 1‐year mortality postkidney transplantation is low, but in select allograft recipients, the risk of death increases considerably.     

Repeated kidney re-transplantation—the Eurotransplant experience: a retrospective multicenter outcome analysis

In Eurotransplant kidney allocation system (ETKAS), candidates can be considered unlimitedly for repeated re-transplantation. Data on outcome and benefit are indeterminate. We performed a retrospective 15-year patient and graft outcome data analysis from 1464 recipients of a third or fourth or higher sequential deceased donor renal transplantation (DDRT) from 42 transplant centers. Repeated re-DDRT recipients were younger (mean 43.0 vs. 50.2 years) compared to first DDRT recipients. They received grafts with more favorable HLA matches (89.0% vs. 84.5%) but thereby no statistically significant improvement of patient and graft outcome was found as comparatively demonstrated in 1st DDRT. In the multivariate modeling accounting for confounding factors, mortality and graft loss after 3rd and ≥4th DDRT (P < 0.001 each) and death with functioning graft (DwFG) after 3rd DDRT (P = 0.001) were higher as compared to 1st DDRT. The incidence of primary nonfunction (PNF) was also significantly higher in re-DDRT (12.7%) than in 1st DDRT (7.1%; P < 0.001). Facing organ shortage, increasing waiting time, and considerable mortality on dialysis, we question the current policy of repeated re-DDRT. The data from this survey propose better HLA matching in first DDRT and second DDRT and careful selection of candidates, especially for ≥4th DDRT.     

Early prediction of renal allograft loss beyond one year

Despite significant improvements in the results of renal transplantation since the introduction of cyclosporin, graft loss beyond the 1st year remains a significant and unresolved problem. In a retrospective analysis, 348 cyclosporin-treated renal transplant recipients with a functioning graft at 12 months were studied. Forty-eight patients in whom graft failure occurred in the 2nd and 3rd years were compared to 300 patients who maintained graft function beyond this time. Both groups were comparable with respect to donor and recipient features. Factors reflecting recipient immunological responsiveness —sensitization, previous transplantation and early rejection episodes-continued to affect graft survival beyond the 1st year. Surprisingly, there was a higher incidence of prior transfusion in the group with graft failure in the 2nd and 3rd years than in those with longer function (65% vs 24%). Serum creatinine levels at 3 and 6 months were also predictive of graft loss amongst patients with a functional graft at 1 year. It remains to be answered whether new immunosuppressive drugs and strategies will overcome these risks for late graft loss.     

肾移植受者死亡原因的病理学分析

分析１９７８～１９９４年间肾移植术后死亡病例中２７例全身尸体解剖资料。其中，各种不同病因的感染见于１７例病人，占６２．９６％。因感染致死者１２例，占４４．４４％。因此感染是肾移植术后的主要并发症。其他并发症包括：肝脏疾患５例，心血管疾病６例，脑血管意外３例，肿瘤１例。对移植术后的上述并发症进行了讨论。