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目的探讨术前群体反应性抗体(PRA)水平对等待肾移植患者接受肾移植的比例和术后长期疗效的影响。方法收集中山大学附属第一医院1998年1月到2012年6月等待肾移植的7 123例尿毒症患者资料,根据术前PRA水平的不同分为5组:A组6 124例,PRA阴性;B组160例,PRA<10%;C组261例,PRA10%~29%;D组374例,PRA30%~80%;E组204例,PRA>80%。比较5组患者接受肾移植的比例,5组患者中接受肾移植者的术前人类白细胞抗原(HLA)错配情况,术后患者和移植肾存活率,术后1年估算肾小球滤过率(eGFR)情况,以及术后移植肾功能恢复延迟(DGF)、急性排斥、慢性排斥和感染等并发症的发生率。结果A组患者接受肾移植的比例为31.9%;随着PRA水平升高,患者接受肾移植比例显著下降,E组接受肾移植比例最低,为7.3%(P<0.05)。在接受肾移植的患者中,随着PRA水平升高,HLA错配数显著降低。A组和B组术后急性排斥和慢性排斥发生率均显著低于E组(均P<0.05),各组DGF和感染发生率差异无统计学意义(均P>0.05)。A组的移植肾存活率优于E组(1年96.4%比89.5%,5年76.8%比63.4%,10年59.7%比47.3%,均P<0.05),术后1年eGFR水平也优于E组(66.7mL/min比45.3mL/min,P<0.05),但各组患者存活率差异无统计学意义(均P>0.05)。结论术前PRA水平越高,肾移植接受率越低,术后发生急性排斥和慢性排斥的风险越高,移植肾的长期预后也越差。
Objective To investigate the effect of preoperative PRA level on the proportion of patients receiving kidney transplantation and the long-term efficacy after renal transplantation. Methods The data of 7 123 uremic patients awaiting renal transplantation from January 1998 to June 2012 in the First Affiliated Hospital of Sun Yat-sen University were divided into 5 groups according to the preoperative PRA levels: 6 124 cases in group A were negative for PRA; 160 cases in group B, PRA <10%; group C 261 cases, PRA 10% -29%; group D 374 cases, PRA 30% -80%; group E 204 cases, PRA> 80%. To compare the proportion of patients who underwent kidney transplantation in five groups, the mismatch of preoperative human leukocyte antigen (HLA), the survival rate of postoperative patients and transplant recipients, the glomerular filtration rate (EGFR), and the incidence of complications such as postoperative delayed graft recovery (DGF), acute rejection, chronic rejection, and infection. Results The proportion of patients who received kidney transplantation in group A was 31.9%. The proportion of patients receiving kidney transplantation was significantly decreased with the increase of PRA level. The proportion of patients receiving kidney transplantation in group E was the lowest (7.3%, P <0.05). In patients undergoing kidney transplantation, the number of HLA mismatches decreased significantly as PRA levels increased. The incidence of postoperative acute rejection and chronic rejection in group A and group B were significantly lower than those in group E (all P <0.05). There was no significant difference in the incidence of DGF and infection between groups (all P> 0.05). The graft survival in group A was better than that in group E (96.4% vs 89.5% at 1 year, 76.8% vs 63.4% at 1 year, 59.7% vs 47.3% at 10 years, both P <0.05), and 1 year after eGFR In group E (66.7 mL / min vs 45.3 mL / min, P <0.05), there was no significant difference in survival between groups (P> 0.05). Conclusions The higher preoperative PRA level, the lower the acceptance rate of renal transplantation, the higher the risk of postoperative acute rejection and chronic rejection, the worse the long-term prognosis of transplant kidney.