老年人肾移植临床特点的分析

目的 探讨≥60岁老年人肾移植的临床特征及免疫抑制剂治疗的特点。方法 对1990年1月～2001年12月1390例肾移植中的152例≥60岁患的临床资料进行分析，将术后使用免疫抑制剂为三联疗法(环孢素A 硫唑嘌呤 泼尼的松)的55例作为A组；术后使用四联疗法(环孢素A 麦考酚酸莫非替酯 泼尼松 抗T细胞单抗)的97例作为B组，B组中51例患术后接受OKT3抗排斥治疗，另46例给予抗IL-2受体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，并与同期非老年肾移植患相同指标进行比较。结果 老年患肾移植后心脑血管并发症以及感染发生率明显高于同期非老年肾移植患，A组和B组的术后1年内并发症发生率分别为83．6％和39．2％；急性排斥发生率分别为21．8％和5．7％；1年人／肾存活率分别为81．8％／78．2％和92．8％／90．8％。结论 老年患肾移植术后心脑血管并发症及感染发生率较高，新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／肾存活率也明显提高。

Clinical features of renal transplantation in the elderly patients

Objective To analyze the clinical features of renal transplantation in the aged and the influence of im-munosuppressant on transplantation result in the elderly recipients. Methods From 1990 to 2001, renal transplantation for 1 390 cases was performed in Xinqiao Hospital and 152 of them were elderly recipients. The clinical data of the aged over 60 after renal transplantation were retrospectively analysed. The aged recipients were divided into group A and group B. Ciclosporin (CsA), azathioprine (Aza) and prednisone were given to the group A. In the group B, in addition to CsA, mycophenolate mofetil (MMF), prednisone and OKT3 were given to 51 aged recipients and dacliximab (Daclizumab, Ze-napax) or basiliximab (Smulect) was injected into the other 46 aged recipients within 2 hours prior to transplantation and on 14th day after-transplantation for prophylaxis of acute rejection. The group B was compared with the group A in complications, the rate of acute rejection and the one-year survival rate of patients/allografts. Results The rate of complication of cardio- and cerebro-vascular disease and infection in the aged recipients were higher than those in the non-elderly recipients. In groups A and B, the rate of postoperative complications was 83.6% and 39.2% , the rate of acute rejection was 21.82% and5.73%, and one-year survival rate of patients/allografts was 81.8%/78.2% and 92. 8%/90.8% , respectively. Conclusions The cardio-and cerebro-vascular disease and infection complications were the main risk factors affecting the outcome of renal transplantation in the senile recipients. The quadruple immunosuppressant regimens could reduce postoperative complications and acute rejection, and improve one-year survival rate of patients/allografts in the aged recipients.