CAJ | 학술논문

目的对肾移植术后存活10年以上受者的临床资料以及期间出现的并发症进行分析和总结.方法回顾性分析1998年12月31日以前接受肾移植的1003例受者资料,分别统计术后存活10年以上的受者和移植肾数量,同时记录相关的存活情况、并发症发生情况以及术后初始免疫抑制方案对受者和移植肾长期存活的影响.结果截至2008年12月31日,存活10年以上的受者有629例,有功能的移植肾占存活10年以上受者的85.37%(537/629).存活10年以上的受者中,采用以环孢素A(CsA)为基础的免疫抑制方案的占94.75%(596/629).移植后发生的并发症有:冠心病57例(9.06%),肝脏损害32例(5.09%),肿瘤29例(4.61%),糖尿病25例(3.97%),脑血管意外16例(2.54%),严重骨髓抑制14例(2.23%),股骨头坏死7例(1.11%),下肢血栓3例(0.48%)及突发性耳聋2例(0.32%).629例存活10年以上的受者中,已死亡49例,其中死于心脑血管意外19例(38.78%)、肿瘤10例(20.41%)、肝功能衰竭9例(18.37%)、感染4例(8.16%)、因经济紧张而放弃治疗3例(6.12%)、死因不详2例(4.08%)和意外2例(4.08%).结论肾移植术后长期存活与移植后初期采用以CsA为主要免疫抑制剂方案有关;而非免疫因素,如心脑血管疾病的防治、早期发现肝功能异常和肿瘤是随访工作中应关注的重点.
목적 대신이식술후존활10년이상수자적림상자료이급기간출현적병발증진행분석화총결.방법 회고성분석1998년12월31일이전접수신이식적1003례수자자료,분별통계술후존활10년이상적수자화이식신수량,동시기록상관적존활정황、병발증발생정황이급술후초시면역억제방안대수자화이식신장기존활적영향.결과 절지2008년12월31일,존활10년이상적수자유629례,유공능적이식신점존활10년이상수자적85.37%(537/629).존활10년이상적수자중,채용이배포소A(CsA)위기출적면역억제방안적점94.75%(596/629).이식후발생적병발증유:관심병57례(9.06%),간장손해32례(5.09%),종류29례(4.61%),당뇨병25례(3.97%),뇌혈관의외16례(2.54%),엄중골수억제14례(2.23%),고골두배사7례(1.11%),하지혈전3례(0.48%)급돌발성이롱2례(0.32%).629례존활10년이상적수자중,이사망49례,기중사우심뇌혈관의외19례(38.78%)、종류10례(20.41%)、간공능쇠갈9례(18.37%)、감염4례(8.16%)、인경제긴장이방기치료3례(6.12%)、사인불상2례(4.08%)화의외2례(4.08%).결론 신이식술후장기존활여이식후초기채용이CsA위주요면역억제제방안유관;이비면역인소,여심뇌혈관질병적방치、조기발현간공능이상화종류시수방공작중응관주적중점.
Objective To summarize the clinical data of renal transplants survived with graft function more than 10 years and the adverse events during this period, and to discuss the main strategies for the long-term survival Methods Survival rate of renal transplants simultaneously survived with graft function > 10 years and grafts was counted respectively in total 1003 renal transplant recipients at our hospital before Dec. 31,1998 retrospectively. Their relevant survival,adverse events and initial post-operative immunosuppressive regimens were recorded simultaneously.Results As of Dec. 31, 2008, the 10-year survival rate of recipients was 62. 7% (629/1003), and recipients with graft function accounted for 85. 37 % (537/629). Of them, 94. 75 % (596/629) recipients received cyclosporine A (CsA) -based immunosuppression plus other antiproliferative immunosuppressive agents. Post-transplantation adverse events included coronary heart diseases in 57 cases (9. 06 %), liver damage in 32 cases (5. 09 %), malignancy in 29 cases (4. 61% ), diabetic mellitus in 25 cases (3. 97 %), apoplexy in 16 cases (2. 54 %), severe bone marrow depression in 14 cases (2. 23 %), femur head necrosis in 7 cases (1.11%), lower-extremity thrombosis in 3 cases (0. 48 %), sudden deafness in 2 cases (0. 32 %). There were 690 survival patients and 49 deaths including 19 (38. 78 %) due to cardiocerebral vascular accidents, 10 (20. 41%) due to malignancy, 9 (18. 37 %) due to hepatic failure, 4 (8. 16 %) due to infection, 3 (6. 12 %) due to treatment abandonment, 2 (4. 08 %) unknown reasons and 2 (4. 08 %) accidental deaths. Conclusion Long-term survival after renal transplantation is associated with the primary medication of CsA as the main immunosuppressive regimen. The non-immunologic factors such as the prevention and cure of cardioeerebral vascular diseases and the early finding of liver functional abnormality and tumor are the main points focused during follow-up.