肾移植1140例次总结

目的 总结肾移植经验、改善移植效果、提高长期康复率。方法 总结1979年1月至2000年6月1140例次肾脏移植资料，分析患者状况、组织配型、供肾情况、移植手术、移植并发症、免疫抑制治疗等对移植效果的影响及其它影响移植效果的因素。结果 1、3、5年人/肾存活率（%）分别为：93.5/88.6、76.4/70.2和65.5/61.4其中近5年的1、3、5年人/肾存活率（%）分别为：95.1/90.2、79.2/75.3和69.9/65.1；超急性排斥发生率2.19%，急性排斥（AR）21.4%，慢性排斥（CR）17.9%移植后发生感染425例，急性肾功能衰竭（ARF）151例，药物毒性作用340例；共死亡336例，因感染死亡占47.3%，心脑血管并发症死亡占34.8%。结论 （1）充分的术前准备是肾移植成功的重要保证，提高肾及移植手术的质量是提高存活率的基础，加强组织配型是提高存活率的关键之一。（2）并发症是影响存活率的重要因素，预防移植肾慢性失功是稀薄标兵 中晚期处理的重点，坚持出院后患者的随访对提高长期康复率有决定性的作用；（3）合理应用免疫抑制剂是移植后治疗的重点，环孢素A（CsA)、霉酚酸酯（MMF）、泼尼松（Pred)三联是目前理想的免疫抑制治疗方案。

Summary about 1 140 case-times of renal transplantation

Objective To summarize the experience of renal transplantation in order to improve transplant effect and to enhance the long-term survival and recovery rate.Methods The data of renal transplantation in 1 140 cases who received renal transplantation from Jan. 1979 to June 2000 were summarized. All the possible factors that could influence the transplant effect such as patients' and donors' conditions, HLA match, surgical procedure, complications, immunosuppressive therapy and son on were analyzed.Results The 1, 3, 5 year survival rate (%) of patient/kidney was 93.5/ 88.6, 76.4/ 70.2 and 65.5/ 61.4 respectively (in recent five years, 95.1/ 90.2, 79.2/ 75.3 and 69.9/ 65.1, respectively). The incidence of superacute rejection (SAR) was 2.19%, of acute rejection 21.4% and of chronic rejection 17.9%. In the posttransplantation, 425 suffered from infections, 151 from ARF and 340 had drug toxicity. Among the 336 dead cases, 47.3% was caused by infection and 34.8% by cardiovascular complications.Conclusions The well preoperation preparation is the assurance of successful transplantation; the high quality of donor's kidney and transplant operation is the basis, and the ideal HLA match is the key step in enhancing survival rate. The various complications are the crucial factors influencing the long-term survival of the patients. The prevention of the chronic failure of graft kidney is addressed as a key point in the middle and last posttransplantation stage, and the strict discharge follow-up has a determinant function in it. The combined medication is also very important in effective prevention of rejection and decrease of drug toxicity. Low dosage of CsA with MMF and Pred is the ideal regimen of immunosuppressive therapy.