中山大学附属第一医院两个阶段肾移植效果比较(附2 562例报告)

[目的]总结中山大学附属第一医院肾移植专科重新组建前后两个阶段肾移植经验.[方法]1972年12月至2004年4月,我院共行肾移植2 562例,根据肾移植专科组建和发展情况,以手术时间1998年1月为界将其分为A组(n=1 318)和B组(n=1 244),比较两个阶段的肾移植效果.[结果]超急性排斥21例:A组17例(1.3%)、B组4例(0.3%)(P＜0.01=0.006 6);加速排斥61例:A组50例(3.8%)、B组11例(0.9%)(P＜0.001);急性排斥298例:A组208例(15.8%)、B组90例(7.2%)(P＜0.001);两组各种排斥发生率差异均有统计学意义(P＜0.001).血管并发症51例:A组37例(2.8%)、B组14例(1.1%)(P＜0.01=0.002 3);输尿管梗阻30例:A组21例(1.6%)、B组9例(0.7%)(P＜0.05=0.040 8);切口感染130例:A组99例(7.5%),B组31例(2.5%)(P＜0.001);肺部感染144例:A组79例(6.0%),其中死亡34例(43%),B组65例(5.2%),死亡18例(27.7%);两组肺部感染死亡率差异具有统计学意义(P＜0.05=0.042 1).A、B两组1年人/肾存活率分别为90.0%/87.2%、97.6%/95.0%,3年人/肾存活率分别为86.1%/84.0%、89.2%/86.1%.[结论]我院肾移植外科技术已日益成熟,良好的组织配型及新型免疫抑制剂的应用,减少了排斥反应及其它并发症的发生,是取得良好肾移植效果的保证.高龄、儿童、下尿路异常等患者肾移植的成功实施,推动了肾移植临床研究的进展,其远期效果仍在观察中.

Comparison of Kidney Transplantation Effects During Two Different Stages in The First Affiliated Hospital of SUN Yat-sen University:A Report of 2 562 Cases

To summarize the experience in kidney transplantation during two different stages in the First Affiliated Hospital of SUN Yat-Sen University. There were 2 562 patients underwent kidney trans-plantation from December 1972 to April 2004. Depending on the historical foundation and development of our department, they were divided into two groups for a retrospective study: Group A (n =1 318) included the patients with transplantation before January 1998, and Group B (n =1 244), after January 1998. Such a study was designedto compare the transplant effects during the two different stages. Among the 2 562 recipients, 21 cases developed hyperacute rejection, among whom 17 (1.3%) in Group A and 4 (0.3%) in Group B (P < 0.01=0.006 6); 61 developed accelerated rejections, 50 cases in Group A (3.8%) and 11 cases in Group B (0.9%) (P < 0.001). The total incidence of acute rejection was 11.6% (298/2 562), 208 in Group A (15.8%) and 90 in Group B (7.2%) (P < 0.001). The statistic significance was found in the three sorts of respective rejections between Group A and B (P < 0.001). There were 51 cases with vascular complications, 37 (2.8%) in Group A and 14 (1.1%) in Group B (P < 0.01=0.002 3). There were 30 cases developing uretaral obstruction, 21 (1.6%) in Group A and 9 (0.7%) in Group B (P < 0.05=0.040 8). The total infections of incisional wound were 130, 99 in Group A (7.5%) and 31 in Group B (2.5%) (P < 0.001). There were 144 patients suffering pulmonary infection, 79 in Group A (6.0%) and 34 in Group B (5.2%). The mortalities of pulmonary infections in Group A and B were 43% (34/79) and 27.7% (18/65) (P < 0.05=0.042 1), respectively. The 1-year survival rates of patients and grafts in Group A and B were 90.0%/87.2% and 97.6%/95.0%, respectively; and the 3-year survival rates were 86.1%/84.0% and 89.2%/86.1%, respectively.[Conclusion]Surgical technology of kidney transplantation today has become mature. Well-matched HLA and new effective immunosuppressants decreased the incidence of rejection and other complications. Successful operation on the old, children and patients with abnormal lower urinary tract makes more rapid progress in kidney transplantation. Good 1-year and 3-year survival rates of patients and grafts in this study are achieved and the long-term effect is now being studied.