2300例次肾移植的临床分析

目的：对1972－2000年10月间2300例次肾移植情况进行临床分析，方法：统计肾移植后受者1、3、5年的人、肾存活率；肾移植主要并发症及其处理原则；影响受者再次移植存活率的因素；HLA－A－抗原／基因配型及群体反应抗体（PRA）检测情况。结果（1）自1985年使用环孢素A（CsA)后1年人、肾存活率（人、肾均存活）为87．33％，3年为80．17％，5年为67．04％。（2）50岁以上肾移植患者353例，1年移植肾存活率83．44％（252／302），1年人存活率85．43％（258／302）。（3）肾移植术后患者心脑血管系统疾病占死亡原因的50．7％，感染占死亡率的13．5％，（4）恶性肿瘤的发病率为1．46％（23／1580）。（5）良好的HLA供－受者配型型可减少术后急性排斥反应的发生率，利用于移植肾的长期存率。结论良好的组织配型，肾移植术后免疫抑制药物的合理应用，对移植术后并发症的预防和及时治疗是提高肾移植术后 人／肾存活率的重要因素。

Clinical analysis of 2 300 kidney transplantations

Objective　To analyze the clinical data of 2 300 renal transplantations from 1972 to Oct. 2000. Methods　The graft survival rate at 1, 3, 5 year, main complications of renal transplantation and treatment, the factors contributive to the mortality and the factors affecting the re-transplant grafts’ survival rate were observed. HLA-antigen-gene typing and population response antibody (PRA) was detected.Results　The graft survival rates at 1, 3, 5 years were 87.33%, 80.17% and 67.04% respectively after administration of CsA since 1985. In the 353 recipients aged over 50 years, one year graft survival rate was 83.44% and 1 year patient survival rate 85.43%. Cardiocerebral vascular diseases were the main diseases, accounting for 50.7% of the factors of death after renal transplantation, infection for 13.5%. The incidence of the malignancy was 1.46% (25/1 580). The incidence of acute rejection was 27%, 35.5%, 22.4%, 20.85%, 0, 0 respectively when the HLA mismatches were 6, 5, 4, 3, 2 and 1. Conclusion　Good HLA match, rational use of immunosuppressants after renal transplantation, the prevention of post-transplantation complications and immediate treatment were the main factors improving long-term graft/patient survival rate.