CAJ | 학술논문

目的总结1908例(2200例次)肾移植手术的临床经验，提高肾移植术后人、肾存活率。方法总结1985年以后人、肾1年、3年、5年的存活率；肾移植主要并发症及其处理原则；影响患者再次移植存活率的因素；HLA-抗原/基因配型及群体反应抗体（PRA）检测。结果（1）自1985年临床使用环孢素A（CSA）后，其1年人、肾存活率为87.3%，3年人、肾存活率为80.2%，5年人、肾存活率为67.0%。（2）50岁以上肾移植患者302例，术后1年移植肾存活率83.4%(252/302)，1年人存活率85.4%(258/302)。（3）肾移植术后患者死亡原因主要是心血管系统疾病及感染。心血管系统疾病占死亡原因的50.7%，感染占死亡率的13.5%。（4）肾移植术后恶性肿瘤的发病率为1.5%(23/1580)。（5）肝损害患者有独特的药代动力学特点。（6）良好的HLA供-受者配型可以减少肾移植术后急性排斥反应的发生率，有利于移植肾的长期存活。在HLA抗原不配合的情况下，受者应尽量选择接受不具有免疫原性抗原/基因的供肾移植。（8）对于慢性排斥反应应采取综合方法进行治疗。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及及时治疗是提高肾移植术后人、肾存活率的重要因素。
목적 총결1908례(2200례차)신이식수술적림상경험，제고신이식술후인、신존활솔。방법 총결1985년이후인、신1년、3년、5년적존활솔；신이식주요병발증급기처리원칙；영향환자재차이식존활솔적인소；HLA-항원/기인배형급군체반응항체（PRA）검측。결과 （1）자1985년림상사용배포소A（CSA）후，기1년인、신존활솔위87.3%，3년인、신존활솔위80.2%，5년인、신존활솔위67.0%。（2）50세이상신이식환자302례，술후1년이식신존활솔83.4%(252/302)，1년인존활솔85.4%(258/302)。（3）신이식술후환자사망원인주요시심혈관계통질병급감염。심혈관계통질병점사망원인적50.7%，감염점사망솔적13.5%。（4）신이식술후악성종류적발병솔위1.5%(23/1580)。（5）간손해환자유독특적약대동역학특점。（6）량호적HLA공-수자배형가이감소신이식술후급성배척반응적발생솔，유리우이식신적장기존활。재HLA항원불배합적정황하，수자응진량선택접수불구유면역원성항원/기인적공신이식。（8）대우만성배척반응응채취종합방법진행치료。결론 량호적조직배형、신이식술후면역억제약물적합리응용、대이식술후병발증적예방급급시치료시제고신이식술후인、신존활솔적중요인소。
Objective To analyze the clinical results of 2 200 renaltransplantations. Methods The following factors were analyzed: (1) the graft survival rates at 1, 3 and 5 years； (2) main factors contributing to the mortality; (3) factors affecting the survival rate of retransplant grafts; (4) features of cancers after renal transplantation; (5) effect of CSA on liver function after renal transplantion; (6) treatments for chronic rejection； and (7) effect of HLA typing on renal transplantation. Results From 1972 to 2000, 2 200 renal transplantations were performed in 1 908 patients (1 337 men and 571 women) with end-stage renal failure in our hospital， Beijing. The graft survival rates at 1, 3 and 5 years were 87.3%, 80.2% and 67.0% respectively, after using CSA since 1985. 302 recipients were aged over 50 years whose one year graft survival rate was 83.4% and one year patient survival rate was 85.4%. Pneumonitis was the dominant death factor after renal transplantation, with an incidence of 4.49% and a death rate of 34.62%. The incidence of positive CMV after renal transplantation was up to 40.3%, in with a death rate of 8.0%. The incidence of tumor after renal transplantation was 1.5%. The most frequent site of tumor was urological system. The patient's liver function before transplantation and the intraindividual variability of bioavailabity to CSA etc. were the major toxic factors of the liver. The incidences of acute rejection were 27%, 35.5%, 22.4%, 20.85%, 0% and 0%, respectively, when the HLA mismatches were 6, 5, 4, 3, 2 and 1. Conclusion Using immunosuppressents reasonably, preventing acute rejection, and achieving good HLA typing are the major factors improving long-term graft/patient survival rate.