肾移植术后存活影响因素分析

目的分析影响肾移植存活的因素,以提高肾移植术后长期存活率.方法采用SAS软件,统计2 016例(2 105次)肾移植受者群体中的33个相关变量.用Kaplan-Meier曲线计算1、3、5、10年移植肾存活率及移植肾半生存期,用Log-rank方法进行单变量分析,采用COX模型多元回归计算相对危险度.结果移植肾1、3、5、10年存活率分别为83%(1 543/1 859)、75%(1 125/1 500)、66%(800/1212)、48%(291/607),剔除有移植肾功能死亡的病例后,存活率则为89%(1 655/1859)、82%(1 230/1 500)、75%(909/1 212)、69%(419/607),两者的移植肾半生存期分别为(8.78±0.14)年和(14.09±0.20)年.与肾移植长期存活关系密切的单变量有供肾缺血时间,移植次数,免疫抑制药(ISA)种类和组合,排斥,移植肾功能恢复正常时间及术后肌酐水平,急性肾小管坏死(ATN),移植肾功能延迟恢复(DGF),急性排斥的治疗方法,感染并发症等因素.结论免疫抑制剂的改进提高了肾移植短期存活率,也显示出长期存活的趋势.提高供肾质量,降低带有移植肾功能的患者的死亡率是现阶段提高移植肾长期存活率的一个最有可能实现的途径.

Cadaver renal transplantation and multivariate analysis for graft survival: a clinical review of 2 016 cases

OBJECTIVE: To review kidney transplantation in the center and analyze the risk factors affecting long-term allograft survival. METHODS: Thirty-two relative variables were analyzed with SAS statistical software. Using Log-rank method, we investigated influence of these variables on short-and long-term survival of grafts. Kaplan-Meier analysis was used to estimate the 1-, 3-, 5-, 10-years graft survival rates and half-life. Proportional hazards regression analysis (Cox model) was used to assess and rank the relative risk of potential variables. RESULTS: The 1-, 3-, 5-, 10-years graft survival rates were 83%, 75%, 66% and 48%. After excluding the patients died with functioning grafts, the 1-, 3-, 5-, 10 years grafts survival rate increased to 89%, 82%, 75% and 69%, respectively. The mean half-life was 8.78 +/- 0.14 and 14.09 +/- 0.20 years, respectively. By Log-rank analysis, factors affecting short- and long-term graft survival were identified as: renal function, duration of graft function became normal, cold-ischemia time, presence of acute rejection, delayed graft function, immunosuppressive regimen, complication, infection, anti-rejection therapy. Cox model multivariate analysis showed that there were 18 factors affecting graft survival. CONCLUSIONS: New immunosuppressive agents not only significantly increase short-term graft survival, but also have the better long-term outcome tendency. Making assurance to get high quality donor organ and minimizing the death with graft function may be the most feasible way to prolong graft survival at present.