高龄患者肾移植126例临床分析

目的 :探讨高龄患者肾移植的临床特点及四联免疫抑制疗法对临床治疗效果的影响。方法 :分析 1990年 1月至 2 0 0 0年 12月 12 5 1例肾移植中 12 6例高龄患者临床资料 ,将术后使用免疫抑制剂为三联疗法 (CsA +Aza +激素 )的 5 5例作组Ⅰ ;而使用四联疗法 (CsA +MMF +激素 +抗T细胞单抗 )的 71例作为组Ⅱ ,组Ⅱ中 4 7例患者术后使用 2周Wu -T3抗排斥治疗 ,另 2 4例应用抗IL- 2R抗体预防急性排斥反应。将两组的术后并发症、急性排斥率及 1年人 /肾存活率相比较 ,并与本院同期非高龄患者相同指标比较。结果 :高龄患者肾移植后心脑血管并发症以及感染发生率均明显高于非高龄患者。组Ⅰ和组Ⅱ患者的术后并发症发生率分别为 74 5 5 %和 38 0 3% ;急性排斥发生率分别为 12 73%和 4 2 3% ;1年人 /肾存活率分别为 81 82 % /78 18%和 97 18% /95 77%。结论 :高龄患者肾移植术后较容易发生心脑血管并发症及感染 ,使用新的四联免疫抑制疗法能有效地降低心脑血管并发症、感染和急性排斥反应的发生率 ,1年人 /肾存活率亦明显提高。

Clinical Study on Renal Transplantation in Aged Recipients:A Report of 126 Cases

Objective:To study the clinical characteristics on renal transplantation for the aged recipients and influence of the new immunosuppressant therapy to transplant results.Methods:Between January 1990 and Dec 2001, 1 251cases renal transplantation were performed in our hospital and there were 126 cases who were aged over 60 years.We have investigated the clinical results on renal transplantation for the patients more than 60 years age.We divided the aged recipients into tow groups,cyclosporine(CsA),azathioprine(Aza) and corticosteroids were given to the first group.In the second group,except for cyclosporine(CsA),mycophenolate mofetil(MMF)and corticosteroids,Wu-T 3 were used in the 47 aged recipients,Daclizumab or Basiliximab were injected in prophylaxis of acute rejection within 2 hours prior to transplantation and 4 days after transplantation to the 24 aged recipients.The second group was comparable to the first group in complications,the rate of acute rejection and the one-year-survival rate of patients/allograft.Results:The rate of cardiovascular and cerebrovascular and infection complications in the aged recipients were higher than it in the non-elderly patients.In tow groups,the postoperative complications was 74.55% and 38.03%;the rate of acute rejection was 12.73% and 4.23%;the one-year-survival rate of patients/allograft was 81.82%/78.18% and 97.18%/95.77%.Conclusion:Cardiovascular and cerebrovascular and infection complications were the main factors that affect the outcome of renal transplantation in the aged recipients.The new immunosuppressant regimens could reduce postoperative complications and acute rejection.The one-year-survival rate of patients/allograft has been improved in the aged recipients.