术前巨细胞病毒感染对肾移植的影响

目的探讨术前巨细胞病毒(cytomegalovirus infection,CMV)感染对肾移植术后急性排斥反应(acute rejection,AR)的影响及术前预防性抗病毒治疗的意义.方法回顾性分析了116例肾移植受体的术前CMV感染和预防性抗病毒治疗情况,根据术前有无CMV感染分为感染组和非感染组,将CMV感染组肾移植受体根据有无预防性抗病毒治疗分为治疗组和非治疗组.同时检测35例正常健康者CMV结果.采用检测CMV-PP65抗原诊断CMV感染.结果术前CMV感染率肾移植受体为63.8%(74/116)高于正常健康者14.3%(5/35).术后发生CMV感染或CMV病非治疗组为5例(15.6%)高于治疗组1例(2.4%).发生急性排斥反应的术前CMV感染组为14例(18.9%)高于非感染组2例(4.8%).术后发生AR治疗组为4例(9.5%)低于非治疗组10例(31.3%).结论肾移植受体术前CMV感染发生率高于正常健康人群.预防性抗病毒治疗可以降低术后CMV感染或CMV病的发生率.术前CMV感染的肾移植受体术后AR发生率高于非感染者.对术前CMV感染患者采取预防性抗病毒治疗可以降低术后AR的发生率.     

Clinical application of real time-polymerase chain reaction in determining cytomegalovirus viral DNA load in renal transplant recipients

Background Cytomegalovirus (CMV) remains a significant clinical problem among immunosuppressed renal transplant patients.Quantitative PCR assays have become the most common methods in the determination of CMV infections in transplant patients.This study was to determine the relationship between CMV infection and the acute rejection of the transplanted kidney.Methods Plasma samples from 77 renal transplant patients that were pre-transplant negative for CMV infection were tested using real-time quantitative PCR and CMV gene-specific primers.The detected viral loads were retrospectively compared with the acute rejection rate and the chronic or mild rejection rates of the renal transplant.Results CMV-DNA was detected in 29 of 77 recipients,yielding a positive rate of detection of 37.7％ for this procedure.Twelve of the 21 recipients (57.1％) who suffered acute rejection had positive CMV-DNA.Among the 56 recipients suffered from chronic or mild rejection,17 (30.4％) had positive CMV-DNA plasma.Moreover,of the 29 recipients who had detectable CMV-DNA after transplant,12 (41.4％) suffered from acute rejection; of the 48 recipients with undetectable CMV-DNA,only nine (18.8％) developed acute rejection.Post-transplant patients with acute rejection had a higher rate (57.1％ vs.30.4％,P=0.03) of post-transplant CMV infection than those with chronic or mild rejection.Conclusion CMV infection is a risk factor of acute renal transplant rejection and CMV infection should be prevented and treated in renal transplant recipients.Chin Med J 2012; 125(19):3575-3577     

肝移植受体巨细胞病毒活动性感染与补体C3、C4水平变化

目的研究肝移植受体发生巨细胞病毒（cytomegalovirus,CMV）活动性感染时补体C3、C4水平变化及其意义。方法应用速率散射比浊法分别检测三组人群肝移植受体外周血补体C3、C4水平。结果肝移植受体CMV活动性感染组C3、C4的水平明显高于无活动性感染组（P〈0.05）,与健康对照组比较无明显差异（P〉0.05）;而无活动性感染组补体C3、C4水平则明显低于健康组（P〈0.05）。结论肝移植术后CMV活动性感染时,补体系统处于激活状态,而激活的补体系统可能参与了移植器官排异过程。     

肾移植术后巨细胞病毒感染与急性排斥反应

目的 :探讨肾移植术后活动性巨细胞病毒 (CMV)感染的发生率、原因以及对急性排斥反应的影响。方法 :检测 182例肾移植受者及其供者术前血清抗CMV抗体 ,受者术后定期PCR法检测体内CMVDNA ,对CMVDNA阳性的部分患者给予抗CMV治疗 ,并比较各组排斥反应的发生率。结果 :无论是供者还是受者 ,术前如血清抗CMV抗体阳性 ,受者术后发生活动性CMV感染者明显增多 ,且急性排斥反应的发生率亦明显增加 ;接受抗病毒治疗急性排斥反应明显减少。结论 :CMV感染是肾移植术后急性排斥反应的原因之一 ,预防和治疗CMV感染对肾移植术后急性排斥反应的防治具有重要意义。     

Alemtuzumab induction therapy in highly sensitized kidney transplant recipients

Background  Immunosuppression for immunologically high-risk kidney transplant patients usually involves antithymocyte globulin induction with triple drug maintenance therapy. Alemtuzumab, a humanized anti-CD52 antibody, was expected to be a promising induction therapy agent for kidney transplantation. However, currently no consensus is available about its efficacy and safety. This study aimed to evaluate the efficacy and safety of alemtuzumab as immune induction therapy in highly sensitized kidney transplant recipients.

Methods  In this prospective, open-label, randomized, controlled trial, we enrolled 23 highly immunological risk patients (panel reactive antibody >20%). They were divided into two groups: alemtuzumab group (trial group) and anti-thymocyte globulin (ATG) group (control group). Patients in the alemtuzumab group received intravenous alemtuzumab (15 mg) as a single dose before reperfusion. At the 24th hour post-operation, another dosage of alemtuzumab (15 mg) was given. The control group received a bolus of rabbit ATG (9 mg/kg), which was given 2 hours before kidney transplantation and lasted until the removal of vascular clamps when the anastomoses were completed. Maintenance immunosuppression in both groups comprised standard triple therapy consisting of tacrolimus, prednisone, and mycophenolate mofetil (MMF). Acute rejection (AR) and infection episodes were recorded, and kidney function was monitored during a 2-year follow-up. χ² test, t test and Kaplan-Meier analysis were performed with SPSS17.0 software.

Results  Median follow-up was 338 days. In both the alemtuzumab group and ATG group, creatinine and blood urea nitrogen values in surviving recipients were similar (P >0.05). White blood cell counts were significantly reduced in the alemtuzumab group for the most time points up to 6 months (P <0.05). One patient receiving alemtuzumab died for acute myocardial infarction at the 65th day post-operation. Two ATG patients died for severe pulmonary infection or cardiac and pulmonary failure. Cumulative 2-year graft survival rate was 90.9% in the alemtuzumab group and 81.8% in ATG group (P >0.05) respectively. There was one graft failure in the alemtuzumab group and two graft failures in ATG group, with all graft failures at tributed to rejection episodes. The alemtuzumab group had a 2-year cumulative freedom from rejection rate of 81.8%, compared with 72.7% for the ATG group (P >0.05).

Conclusion  Alemtuzumab induction therapy for highly sensitized kidney transplant recipients is an effective and safe protocol yielding an acceptable acute rejection rate.

     

舒莱预防肾脏移植物急性排斥反应的随机对照试验研究

目的：探讨白细胞介素2受体单克隆抗体——舒莱（Simulect）对移植肾急性排斥反应的预防作用以及用药的安全性与药物的毒副作用。方法：将我器官移植移植中心1999年3月～2002年10月共46例肾移植受者为研究对象，随机分成舒莱组（23例）和对照组（23例），两组肾移植术后均接受以Neoral为基础的三联免疫抑制剂。舒莱组术前2h和术后4d各给予舒莱20mg静脉滴注。观察急性排斥反应、Neoral、皮质激素和硫唑嘌呤用量及药物的毒副作用。实验室检测血CsA浓度和肝肾功能。结果：研究结果表明，舒莱组无1例发生急性排斥反应，对照组术后8周内发生3例4次急性排斥反应。两组均未发生明显的毒副作用。两组间Neoral用量及血CsA浓度无明显差异。对照组因发生急性排斥反应，8周内皮质激素用药量总量大于舒莱组。结论：舒莱对移植肾急性排斥反应具有明显的预防作用，且用药方法简便，疗程短，无明显的毒副作用。     

Effect of pre-transplantation hemoglobin concentration on prognosis of renal transplant recipients

Background  For the renal transplant recipients, anemia is one of the common complications and becomes a major medical issue before transplantation. Haemoglobin (Hb) is used as a prognostic indicator, although the optimal pre-transplantation Hb concentration associated with positive prognosis is still controversial. The aim of this study was to detect the optimal Hb concentration on predicting the graft survival and function.

Methods  A retrospective cohort study was conducted by reviewing the medical records of the patients who received renal transplantations at our center from January 2004 to June 2008. Patients were divided into two groups: high Hb group (≥100 g/L, n=79) and low Hb group (<100 g/L, n=63). There was no significant difference between the two groups regarding sex, age, blood type and tissue types. Renal function among the two groups was measured and compared. Panel reacting antigens (PRA) of all the recipients were negative. The effect of preoperative hemoglobin concentration on the postoperative renal function recovery in both groups was further analyzed.

Results  A total of 14 acute rejection episodes occurred, including 5 patients in the high Hb group (7.9%) and 9 in the low Hb group (11.4%, P >0.05). The serum creatinine level at one-year post-transplantation of the low Hb group was significantly higher than that of the high Hb group ((117.8±36.3) μmol/L vs. (103.1±35.5) μmol/L, P <0.05). For one-year actuarial patient and graft survival, incidence of delayed graft function (DGF), serum creatinine concentrations at 1, 3, 6 months post-transplantation, the incidence of cytomegalovirus (CMV) infection, post-transplantation anemia (PTA) and post-transplantation diabetes mellitus (PTDM) of both groups, there were no statistically significant differences.

Conclusion  Pre-transplantation Hb concentration has significant effect on one-year creatinine concentration, but can not significantly affect acute rejection episodes, DGF, PTA, CMV infection and PTDM.

     

Preoperative single-bolus high-dose antithymocyte globulin as induction therapy in sensitized renal transplant recipients

Background Immunological sensitization remains a major problem following renal transplantation. There is no consensus for the management of sensitized renal allograft recipients. The patients become tethered to dialysis while waiting for compatible donors. This study was designed to evaluate the efficacy and safety of preoperative single- bolus high-dose antithymocyte globulin (ATG) as induction therapy in sensitized renal transplant recipients.Methods A total of 56 patients were divided into two groups according to the level of panel reactive antibody (PRA): non-sensitized group (PRA&lt;10%, n=30) and sensitized group (PRA≥10%, n=26). The characteristics of the recipients and donors were comparable between the two groups. Mycophenolate mofetil (MMF, 1 g) or ATG (iv. 9 mg/kg) were given preoperatively in the two groups as induction therapy. After the transplantation, the patients were treated with standard triple therapy regimen consisting of tacrolimus (FK-506) or cyclosporine A, MMF, and prednisolone. Acute rejection (AR) and infection episodes were recorded and renal function was monitored during a 12-month follow-up. χ(2) test and t test were used to analyze the data.Results During the follow-up, 6 patients (20.0%) suffered AR episodes in the non-sensitized group and 4 (15.4%) in the sensitized group (P=0.737); 8 patients (26.7%) experienced 11 infection episodes (average, 1.4 episodes per infected patient) in the non-sensitized group, and 6 (23.1%) experienced 10 infection episodes (average, 1.7 episodes per infected patient) in the sensitized group (P=0.757, 0.890). The safety of the drugs, which was assessed by the occurrence of side effects, was comparable between the two groups. The hospital stay was 13－25 days (mean, 16.7±3.3) in the non-sensitized group and 14－29 days (mean, 16.2±3.1) in the sensitized group, respectively (P=0.563). No delayed graft function (DGF) was observed in all the patients. Both the 12-month actuarial patient and graft survival rates were 100% in the two groups.Conclusion Preoperative single-bolus high-dose ATG is an effective and safe induction therapy yielding acceptable acute rejection rate in sensitized renal transplant recipients.     

乙型肝炎病毒携带者肾移植术后应用他克莫司和环孢霉素A的临床研究

目的 比较他克莫司和环孢霉素A在乙型肝炎病毒携带者肾移植术后的疗效和安全性.方法 符合入选标准的109例肾移植患者,随机分成他克莫司(FK506)治疗组(52例)和环孢霉素A(CsA)治疗组(57例),随访2年,比较两组的人肾存活率、急性排斥反应(AR)发生率、肝功能异常发生率和药物转换率等.结果 CsA和FK506组的2年人肾存活率分别为86.0%/73.7%和94.2%/90.3%(P＜0.05).AR发生率分别为10.5%和9.6%(P＞0.05).CsA组和FK506组的肝功能异常发生率分别为26.3%和15.4%(P＜0.05).CsA组有21.1%的患者接受静脉护肝药物治疗,而FK506组为9.6%(P＜0.05).CsA组有14.4%的患者转换为FK506,而FK506组没有病人转成CsA(P＜0.05).转换后,谷丙转氨酶/谷草氨酶在10～50 d内由[(255.13±31.38/201.88±21.25)U/L)]降至[(31.25±11.50/25.13±9.68)U/L](P＜0.01).结论 对乙型肝炎病毒携带者肾移植患者,FK506比CsA有更好的疗效和更高的安全性,可作为首选的基础免疫抑制剂.     

Cytomegalovirus infection as a complication of OKT3 therapy in kidney transplant recipients

We compared the incidence of clinical CMV illness in 25 renal transplant recipients treated with OKT3 for steroid resistant cellular rejection with 88 renal transplant patients treated only with conventional immunosuppression (cyclosporin A and steroids). Nine (36%) patients in the OKT3 group developed CMV illness compared to (2.3%) amongst those treated conventionally (p<0.0005). Patients who received OKT3 were divided into four groups according to the CMV antibody status of the donor and recipient. Six of the 9 episodes of CMV infection occurred in patients not previously exposed to CMV, who received a kidney from a CMV positive donor. Three (12%) of the patients treated with OKT3 died of CMV disease. A further 2 patients died of other causes giving an overall mortality in the OKT3 treated group of 20%. We concluded that when OKT3 therapy is used in association with donor/recipient CMV mismatch it is associated with a high CMV morbidity and mortality.     

肾移植受者BK病毒感染的临床诊断及治疗

目的 探讨肾移植受者BK病毒(BKV)感染的诊断及治疗方法.方法 选取肾移植术后48个月内的患者共227例.采集其血、尿样本,行BKV尿沉渣细胞学计数与实时荧光定量PCR检测病毒拷贝.对部分肾移植受者进行移植肾活检.将尿或血中BKV DNA阳性患者80例分成干预组(51例)与对照组(29例).干预组进行调整免疫抑制剂:19例环孢素A(CsA)减量,22例他克莫司(FK506)减量,10例FK506转换成CsA;对照组不进行干预,并且密切监测急性排斥反应.干预3个月后再次检测,比较组内和组间干预前后BKV活化指标的差异.结果 227例受者的尿decoy细胞、BK病毒尿症与病毒血症的阳性率分别为33.O%、33.5%和15.4%.干预组干预后尿decoy细胞、尿和血BKV数量的中位水平均为O,明显低于干预前(5.0个/10HP,1.50 x 104拷贝/ml,0拷贝/ml,均P<0.01).对照组观察前后尿decoy细胞、血BKV数量的中位水平差异无统计学意义(6.0个/10HPvs 5.0个/10HP、0拷贝/ml vs 0拷贝/ml,均P>0.05),尿BKV数量观察结束时上升(观察前:0.79×104拷贝/ml,观察后:2.21 x104拷贝/ml,P<0.01).上述各项指标干预前后的差值在干预组与对照组间差异均有统计学意义(均P<0.05).干预过程中所有患者均未出现急性排斥反应.确诊BKV相关性肾病4例,其干预治疗后尿decoy细胞计数以及血、尿BKV DNA均明显降低,移植肾功能有所恢复.结论 定量尿沉渣细胞学检测简单、易行、敏感,可以作为BKV活化的指标,间接反映肾脏病理情况.也可检测血、尿BKV DNA了解病毒活化情况、筛查BKV相关的移植肾肾病.减少免疫抑制剂剂量或换FKS06为CsA治疗肾移植术后BKV感染效果良好.     

供体脾灌注对高度致敏肾移植受者嵌合体形成的影响

目的探讨供体脾灌注对高度致敏肾移植受者稳定期嵌合体形成及移植肾功能的影响。方法对16例高度致敏患者进行配对分组,实验组肾移植术中先予供体脾灌注40min,前瞻性观察脾灌注对患者术后6个月内嵌合体形成、移植肾排斥反应发生及移植肾功能的变化。结果脾灌注后受者外周血中供者来源的有核细胞数量显著增加,受者形成稳定嵌合体的时间较早,例数比对照组更多;肾移植术后脾灌注组排斥反应发生时间较对照组延迟,排斥反应严重程度明显较对照组轻微;术后6个月时,脾灌注组患者血肌酐值低于对照组。结论供体脾灌注可以显著提高高敏肾移植受者外周血中供者来源的有核细胞数量,减轻排斥反应强度,从而促进受者嵌合体的形成,有利于改善稳定期移植肾功能。     

肾移植术后由霉酚酸酯向硫唑嘌呤转换的必要性与安全性研究

目的探讨同种肾移植术后免疫抑制治疗由霉酚酸酯(MMF)转换为硫唑嘌呤(AzA)的必要性与安全性。方法对门诊随访的87例肾移植术后低危患者进行转换药物的前瞻性研究,按随机、开放原则分为两组：转换组42例,在术后满6个月从霉酚酸酯转换为硫唑嘌呤,对照组45例,在术后一直用霉酚酸酯。观察对比各组的移植肾功能指标、排斥反应、并发症及药物毒副作用情况至术后满18个月或出现终点事件为止,评价药物转换的安全性。结果转换组与对照组在移植肾无事件生存率及排斥反应发生率等治疗指标方面无显著差异;转换组的肝损害和白细胞减低发生率高于对照组,经调整药物剂量和辅助治疗后绝大多数可恢复。结论在我国现实经济状况和医疗体制下,部分患者在肾移植术后由MMF转换为硫唑嘌呤是有必要的,在一定条件下也是安全有效的;远期效果尚有待进一步研究。     

Simulect和OKT3诱导治疗应用于肾移植临床的疗效比较

目的评价Simulect和OKT3作为肾移植诱导治疗的有效性和安全性.方法将170例首次肾移植受者随机分为两组:Simulect组62,OKT3组108例.所有患者免疫抑制维持治疗均用环孢素A(CsA)/他克莫司(FK506) 霉酚酸酯(MMF) 泼尼松(Pred)三联.Simulect组:分别于术前2 h和术后4 d使用20mg Simulect:OKT3组:OKT3每天5 mg静滴,从术后第1天开始,连用7～10 d.观察两组在肾移植术后1年内急性排斥反应(AR)、移植肾功能延迟恢复(DGF)、毒副作用和人/肾存活情况.结果有34例发生AR,Sinulect组6例,OKT3组28例(P＜0.05),其中OKT3组5例出现2次或2次以上AR,7例AR需要ATG治疗逆转.移植肾功能延迟恢复(DGF)、细胞因子释放综合征、过敏反应等方面,Simulect组发生率明显低于OKT3组(6vs32,0vs49,0vs31,P＜0.01).Simulect组感染发生率低于OKT3组(16vs45;P＜0.05).OKT3组有2例移植肾切除,1例死于严重肺部感染.结论Simulect在肾移植免疫诱导治疗中疗效显著,副作用少,是一种强效安全的免疫抑制剂.     

2剂赛尼哌预防肾移植术后急性排斥反应的应用研究

目的 :探讨赛尼哌在预防同种肾异体移植术后急性排斥反应的作用。方法 :回顾分析了已随访 1年的 32例应用 2剂赛尼哌患者的临床效果 ,并以同期肾移植 92例作为对照组。结果 :赛尼哌组在 3月内急性排斥反应发生率 (3.1% )显著低于对照组 (2 3.9% ) (P <0 .0 5 ) ,在感染及副作用方面与对照组无显著性差异。结论 :2剂赛尼哌加上CsA ,MMP ,Pred联合应用的免疫抑制方案对预防同种尸体肾移植受者的急性排斥反应的发生是安全有效的。     

135例肾移植受者移植物丢失的原因分析

目的 探讨肾移植术后受者移植肾丢失的原因。方法 回顾性分析 2002年1月1日~2022 年1月1日在中国人民解放军总医院第八医学中心肾移植术后移植物发生丢失的135例受者临床资料。结果 受者移植肾丢失135例,移植肾丢失原因包括排斥反应70例（51.8%）、受者带功能死亡37例（27.4%）、外科并发症12例（8.9%）、药物毒性4例（3.0%）、耐碳青霉烯肺炎克雷伯菌感染4例（3.0%）、多瘤病毒相关性肾病3例（2.2%）、原发性无功能肾2例（1.5%）、原发病复发2例（1.5%）、肾前性急性肾衰1例（0.7%）。结论 肾移植术后受者移植物丢失原因主要原因是排斥反应,次要原因是受者带功能死亡,其他原因少见。     

Low molecular weight heparin prophylaxis increases the incidence of lymphocele after kidney transplantation

Lymphocele formation after kidney transplantation has become more frequent at our department after the introduction of routine thromboembolic prophylaxis with low molecular weight heparin (LMWH). A consecutive series of 130 kidney transplant recipients were included in a retrospective study. Fifty-eight patients received prophylaxis and 72 did not. Other background data between the two patient groups was comparable. Lymphocele was diagnosed by ultrasound. Lymphocele formation was significantly more common (p<0.01) among patients who received LMWH prophylaxis (43%) than patients who did not (20%). There was no increase in bleeding-related complications in the prophylaxis group. An interesting finding was that, in the prophylaxis group, fewer grafts were lost due to vascular complications or early rejection, leading us to conclude that the use of LMWH increases the incidence of lymphocele formation after kidney transplantation, but may also reduce early graft loss due to thrombosis and vascular rejection.     

心脏死亡供者肾移植48例临床分析

目的:探讨终末期肾病患者接受心脏死亡无偿器官捐献(DCD)供者移植后的恢复情况及此类供体对受者及移植物术后的影响。方法:对48例终末期肾病患者接受DCD捐献的肾脏后行同种异体肾移植术,并对其术前和术后的诊疗及随访血肌酐、移植物及受者存活情况进行回顾性分析。结果:48例受者中无1例出现移植肾原发性无功能(PNF),18例受者术后出现肾功能延迟恢复(DGF),其发生率为37.5%,DGF组与无DGF组受者及移植肾生存率比较,差异无统计学意义(分别P=0.098,P=0.447)。48例受者中有7例(14.6%)受者移植肾丢失,其他41例受者随访时间为0.5~23(中位数8)个月,39例(95.1%)受者移植肾功能恢复正常。在1,3,6,12个月移植物的存活率分别为95.7%,93.0%,90.0%,87.5%,患者的存活率分别为100%,94.9%,90.0%,87.5%。结论:在我国尚无脑死亡法的环境下,DCD是解决我国器官移植界瓶颈的重要手段,是器官来源的重要部分,并且有着较好的短中期预后。     

肾移植术后巨细胞病毒检测的临床意义

目的　探讨肾移植术后检测巨细胞病毒感染的意义。方法　利用酶联免疫吸附法 (Enzymelinkedimmunosor bentassay ,ELISA)以及聚合酶链反应 (Polymerasechainreaction ,PCR)检测肾移植术后受者血清中的抗 CMV抗体及CMV DNA。结果　检测了 72例肾移植术后的受者抗 CMV抗体及CMV DNA ,抗 CMV抗体及CMV DNA阳性率均明显高于术前(P <0 0 1) ,其中 2 5 %的CMV感染者发展为CMV病。移植术后CMV DNA阳性者发生急性排斥反应的几率明显高于CMV DNA阴性者。结论　检测肾移植受者血清中的抗 CMV抗体及CMV DNA可以协助诊断肾移植受者是否感染CMV以及引起的CMV病 ,对临床治疗肾移植术后CMV病有着重要的意义     

Simulect 和 Zenapax 应用于肾移植诱导治疗的5年临床观察

目的评价2剂Simulect和5剂Zenapax在肾移植中诱导治疗预防急性排斥反应(AR)的有效性、安全性以及对近、远期人/肾存活的影响。方法选择1999年4月~2001年4月首次肾移植患者102例,分成Simulect组(54例)和Zenapax组(48例),在三联免疫抑制剂基础上(环孢素A/FK506、骁悉、皮质激素)加用Simulect(术前2h和术后第4天分别予20mg静滴)或Zenapax(1mg.kg-1.d-1,最大剂量100mg,首剂术前2h,此后每2周1剂,共5剂)。观察术后3个月内肾功、AR、移植肾功能延迟恢复(DGF)、急性肾小管坏死情况;术后5年内肾功、排斥反应、并发症及人/肾存活情况。结果术后3个月内AR发生率明显降低(Simulect组:14.8%;Zenapax组:14.6%);首次AR发生时间延迟;激素治疗对大部分AR有效;5年内再次排斥反应发生率为9.3%(Simulect组)和6.3%(Zenapax组)。术后肾功能恢复明显加快,早期及远期肾功能良好。未出现细胞因子释放综合征,仅2例DGF。5年内,感染、糖尿病、高脂血症、恶性肿瘤等未见增加。5年人/肾存活良好,均达95%以上。结论2剂Simulect和5剂Zenapax预防肾移植术后AR的效果好、安全性高,有利于早期肾功能恢复和远期人/肾存活。