肾移植治疗常染色体显性遗传性多囊肾病患者的临床效果分析（附43例报告）

目的探讨肾移植治疗常染色体显性遗传性多囊肾病（多囊肾）患者的疗效。方法多囊肾患者43例（多囊肾组）,在不切除原双侧肾脏的前提下,进行肾移植,以同期50例原发病为非多囊肾的肾移植患者作为对照组,进行随访研究。比较两组的术后1、3、5年人、肾存活率及排斥反应发生情况,通过肾脏B超检查多囊肾组患者术前与术后移植肾的体积变化,记录多囊肾组的并发症发生情况。结果多囊肾组肾移植术后1、3、5年人存活率分别为95.3%、90.6%、90.6%,术后1、3、5年肾存活率分别为95.3%、88.3%、83.7%。对照组相应为96.0%、92.0%、90.0%,94.0%、92.0%、88.0%,两组比较差异无统计学意义（P〉0.05）。两组的急性排斥反应发生率比较差异亦无统计学意义（P〉0.05）。多囊肾组术后3～6个月原肾明显缩小,1年后体积基本稳定,跟踪观察1～15年肾脏体积变化不明显。移植后血尿逐渐减轻,7～10d后消失。12例在移植后5～10周反复出现肉眼血尿,均经抗感染治疗后消失。多囊肾患者移植后仍需要应用药物控制血压。多囊肾组尿路感染发生率高达40%。32例多囊肾合并多囊肝,术后发生肝功能损害7例。结论多囊肾患者采用不切除原肾的肾移植效果满意,移植后应严密观察患者移植物肾功能、血尿和感染情况,及时对症处理。

Clinical study on kidney transplantation in polycystic kidney disease

Objective To study the outcome of kidney transplantation in autosomal dominant polycystic kidney disease（ADPKD）.Methods Forty-three patients of ADPKD（ADPKD group）underwent kidney transplantation without removing original kidney.And 50 cases undergoing kidney transplantation for other di-seases were chosen as control group.Both groups were followed up during the research.The 1-year,3-year and 5-year survival rates of patients or kidney grafts and rejections were evaluated after kidney transplantation.The sizes of polycystic kidney and transplanted kidney were measured by B ultrasound and the complication was recorded in ADPKD group.Results In the ADPKD group,1-year,3-year and 5-year patient survival rates were 95.3 %,90.6 % and 90.6 %,while 1-year,3-year and 5-year kidney survival rates were 95.3 %,88.3 % and 83.7 %.In the control group,1-year,3-year and 5-year patient survival rates were 96.0 %,92.0 % and 90.0 %,while 1-year,3-year and 5-year kidney survival rates were 94.0 %,92.0 % and 88.0 %.No significant difference of the rates was observed between the two groups（P0.05）.There was no significant difference in the incidence of acute rejection between the two groups（P0.05）.The size of polycystic kidney shrank 3-6 months after transplantation and became steady 1 year after transplantation.And there was no obvious change in the size of polycystic kidney from 1 to 15 years after transplantation.The hematuria was gradually alleviated and disappeared in 7-10 days after transplantation.The gross hematuria was repeatedly observed in 12 cases in 5-10 weeks after transplantation and was cured by anti-infection.The blood pressure of ADPKD patients was efficiently controlled with drug after transplantation.The rate of urinary tract infections for ADPKD group was 40 %.Seven cases of 32 ADPKD patients combined with polycystic liver developed liver function damage after transplantation.Conclusion The satisfactory clinical results can be obtained without removing the original polycystic kidney.Careful monitoring of kidney function,hematuria and the urinary tract infections is needed after transplantation.