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目的 总结肾移植的临床经验 ,探讨影响肾移植存活的因素 ,提高长期存活率。 方法 回顾性总结 2 12 3例肾移植病例的临床资料 ,对人和 (或 )肾存活率 ,供肾的切取、灌注、热冷缺血时间对移植的影响 ,植肾技术、免疫抑制剂的应用 ,HLA配型 ,群体反应抗体 (PRA)检测及术后并发症的发生情况等进行了分析。 结果 1978～ 1990年 4 2 3例中发生超急性排斥反应者 9例 (2 1% ) ,急性排斥反应 198例 (46 8% ) ,1,3和 5年人和 (或 )肾存活率为 86 7% / 76 3% ,72 5 % / 6 7 9%和6 9 5 % / 5 9 3% ;1991～ 2 0 0 1年 ,共 170 0例肾移植 ,其中未发生超急性排斥反应 ,急性排斥反应 2 5 2例(14 8% ) ,1,3和 5年人和 (或 )肾存活率高达 98 6 % / 96 7% ,93 1% / 87 3%和 88 1% / 83 6 %。 结论 适应证的选择、高质量的供肾是保证肾移植成功的关键 ;PRA的检测、良好的HLA配型有利于减少移植肾的早期失功能并提高肾移植长期存活率 ;加强对肾移植患者的随访 ,指导康复治疗 ,对患者能否长期存活有重要意义。
Objective To summarize the clinical experience of renal transplantation, to explore the factors that affect the survival of renal allografts, and to improve the long-term survival rate. Methods The clinical data of 2 123 cases of renal transplantation were retrospectively reviewed. The effects of renal and / or renal survival, donor excision, perfusion, and ischemia-reperfusion time on graft, renal transplantation, immunosuppressive agents Application, HLA matching, group reaction antibody (PRA) detection and the incidence of postoperative complications were analyzed. Results Nineteen (21%) cases of hyperacute rejection occurred in 423 cases from 1978 to 1990, and 198 cases (46.8%) of acute rejection. The survival rates of one, three and five years old and / or kidney were From 1991 to 2001, a total of 170 0 cases of renal transplantation were performed, in which no hyperacute rejection occurred, Fifty-two (14.8%) cases of acute rejection had a survival rate of 98.6% / 96.7%, 93.1% / 87.3%, and 88.1% / 83% at 1,3 and 5 years %. Conclusion The selection of indications and high quality donor kidney are the keys to ensure the success of renal transplantation. The detection of PRA and good HLA matching will help to reduce the early loss of graft function and improve the long-term survival rate of renal allograft. Follow-up, guiding the rehabilitation of patients with long-term survival is of great significance.