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。

The impacts of initial graft function on the long-term outcome of renal transplantation

Objective To clarify the impacts of early graft function on the long-term outcome of cadaveric renal transplantation.Methods The data of 652 cases of renal transplantation from 1990 to 1998 were reviewed.All the cases were classified into 3 groups based on early renal function after surgery.Recipients who had immediate graft function(IGF) were assigned to group A(473 cases);those who had slow graft function(SGF)(no need for dialysis) to group B(82 cases);those who had delayed graft function(DGF) to group C(97 cases).The 5-,10-year patient/graft survival rate,death rate with graft and acute rejection rate in the first year were compared among the 3 groups.Results The 5-,10-year patient/graft survival rates were 74.0%/70.2%,66.9%/60.3% in group A;64.6%/61.0%,62.2%/42.2% in group B and 60.8%/43.3%,55.7%/23.0% in group C,respectively.The 5-,10year patient survival rates of groups A and B were higher than those of group C.The 5-year graft survival rate of group A was higher than that of group C.There was no significant difference between groups A and B in 5-year patient/graft survival rate.The data showed that the 10-year patient/graft survival rates of group A,group B and group C were in decreasing order;there were statistically significant differences among the 3 groups.The acute rejection rates of groups A,B and C at 1 year were 20.1%,30.5% and 43.2%,respectively.There were also statistically significant differences among the 3 groups.The death rates with graft of groups A,B and C at 1 year were(4.7)%,4.9% and 12.4%,respectively,indicating it was higher in group C and there was no significant difference between groups A and B.After excluding cases who had acute rejection and who died with grafts,the comparison showed no significant difference of long-term survival rate among the 3 groups.Conclusions The impacts of initial graft function on the long-term outcome of renal transplantation were obvious.And DGF had the most obviously adverse impacts.The prognosis of SGF was between IGF and DGF.The adverse impacts of SGF or DGF on the long-term outcome of cadaveric renal transplantation were attributed to the higher incidence of acute rejections and complications.