肾移植术1053例次总结

目的　对临床肾移植的经验进行总结。方法　回顾分析 10 5 3例次肾移植受者的临床资料 ,从供肾及移植情况、术后并发症及处理、免疫抑制剂的应用、HLA配型及群体反应性抗体检测等对移植效果的影响等几个方面进行分析总结。结果　 1988年前免疫抑制治疗采用硫唑嘌呤 (Aza)和泼尼松 (Pred)二联用药 ,人 /肾 1年存活率为 6 9.3% /6 9.0 % ,3年为 4 3.0 % /42 .6 % ,5年为 30 .7% /2 7.8% ;1989年后采用环孢素A(CsA)、Aza和Pred三联用药 ,人 /肾 1年存活率为 93.2 % /92 .4 % ,3年为 79.3% /78.2 % ,5年为 6 6 .2 % /6 4 .2 %。术后早期并发症以急性排斥反应为主 ,晚期主要是移植肾慢性功能丧失 ,后者是导致受者死亡的主要原因。只要治疗及时 ,80 %的急性排斥反应能够得到逆转。结论　良好的供肾和组织配型 ,术后免疫抑制药的合理应用 ,并发症的预防和及时治疗 ,是提高肾移植术后人、肾存活率的重要保证

A summary of 1053 cases/times of kidney transplantation

Objective To summarize the experience on clinical kidney transplantation.Methods 1 053 cases of kidney transplantation were analyzed retrospectively. Factors such as donors conditions, surgical procedure, complications, immunosuppressive therapy, HLA match, and so on were analyzed. Results The 1 , 3 , 5 year survival rate (%) of patient/kidney was 69.3 / 69.0 , 43.0 / 42.6 and 30.7 / 27.8 respectively with the immunosuppressive regime of Aza and Pred before 1988. With the application of CsA after 1989 the survival rate (%) was 93.2 / 92.4 , 79.3 / 78.2 and 66.2 / 64.2 respectively. Acute rejection was the main early complication, 8 % of which could be reversed by prompt therapy. Chronic graft dysfunction was the main complication in the late period, and the main reason for patients' death.Conclusion Good donors conditions and HLA match, reasonable immunosuppressive regime, prevention and prompt therapy of complication after transplantation will improve the patient/kidney survival rate.