停用免疫抑制药对肾移植肺部感染患者人肾长期存活的影响

目的：探讨停用免疫抑制药对肾移植受体及移植肾长期生存的影响。方法：选取2005年12月至2014年8月在中南大学湘雅医院器官移植中心接受肾移植手术后出现肺部感染的患者共104例，其中50例患者在肺部感染治疗期间停用免疫抑制药，作为停药组，余54例作为对照组。比较两组间受者以及肾5年累积生存率及感染期间生化指标的变化情况。结果：停药组的受体5年累积生存率明显低于对照组[(69.8±7.0)%对比(94.2±3.2)%，P=0.001]，但移植肾生存率两组间差异无统计学意义[(81.7±6.6)%对比(90.9±4.3)%，P=0.113]。肺部感染康复后，停药组受体的长期生存率与对照组相比差异无统计学意义(P=0.979)。结论：肺部感染严重危害肾移植受体的生存；停用免疫抑制药对于肾移植术后严重肺部感染患者而言并不影响患者和移植肾的长期存活。

Transient stopping immunosuppressive agents during the post-transplant pulmonary infection does not affect the long-term outcome of renal transplantation

Objective: To determine the eff ect of transient withdrawal of immunosuppressive agents duringthe treatment of pulmonary infection on long-term survival of patients and graft s.Methods: A total of 104 patients with post-transplant pulmonary infection were enrolled in thisstudy. Th ese patients received renal transplantation in Center for Organ Transplantation, XiangyaHospital, Central South University, during December 2005 and August 2014. Among them, 50patients stopped immunosuppressive agents during the treatment of infection. These patientsserved as stopping drug (SD) group, whereas the remaining patients who served as a control groupdid not stop immunosuppressive drugs. Th e fi ve-year cumulative patient survival, graft survival, andlaboratory results were compared between the 2 groups.Results: The five-year cumulative patient survival rates in the SD group were significantly lowerthan those in the control group [(69.8±7.0)% vs (94.2±3.2)%, P=0.001]. There was no significantdifference in the allograft survival rates between the 2 groups [(81.7±6.6)% vs (90.9±4.3)%,P=0.113]. In patients who survived from pulmonary infection, there was no significant difference inlong-term survival rates between the 2 groups (P=0.979).Conclusion: Pulmonary infection impacts allograft survival after patients underwent renaltransplantation. Transient stopping immunosuppressive agents during the treatment of infection is asafe and necessary treatment strategy for patients with serious post-transplant pulmonary infection.