摘要
对同种异体肾移植１０５１例１０８２例次进行总结。术后发生超急性排斥反应１２例次，加速性排斥反应３例次，急性排斥反应２８９例次，慢性排斥反应９３例次。人／肾总存活率：１年９４．７％／８７．６％、３年８９．８％／７９．７％、５年８８．３％／７９．１％、１０年５０．０％／３８．６％。最长者存活１６年５个月。１０８２例次的临床研究表明：（１）尸体肾移植是治疗晚期肾脏疾病的有效方法。（２）适应证的选择是保证肾移植成功的关键。（３）良好的ＨＬＡ配型有利于减少移植肾的早期失功和提高肾移植的长期存活率。（４）高质量的供肾、快速的取肾和熟练的植肾手术是保证肾移植成功的重要条件之一。（５）应坚持ＡＢＯ血型、淋巴细胞毒性试验及ＰＲＡ配型工作。（６）合理的应用免疫抑制剂，将激素减到最低量及环孢素血浓度的监测甚为重要。（７）ＡＴＧ或ＯＫＴ３是当前治疗移植肾难治性排斥反应最有效的免疫抑制剂之一。（８）感染是肾移植失败的重要原因，要充分做好预防感染的工作。（９）彩色多普勒超声和ＥＣＴ测定是一种方便、快速、敏捷诊断急性排斥反应的手段。（１０）加强对肾移植患者随访，指导康复期治疗，随时调节免疫抑制剂，这对患者能否长期存活有重要意义。
1 082 cardaveric kidney transplantations were performed for 1 051 patients. Super acute rejection occurred in 12, accelerated rejection in 3 and acute rejection episodes in 289. The 1 year survival rate of patient/kidney was 94.7%/87.6%, the 3 year survival rate 89.8%/79.7%, the 5 year survival rate 88.3%/79.1% and the 10 year survival rate 50.0%/38.6%. The longest kidney survival has been 16 years and 5 months. The conclusion was drawn as follows:(1) kidnay transplantation is the treatment of choice for end stage renal failure.(2) well matched HLA is of prime importance to reduce early allograft loss and to increase long term survival.(3) quick adequate harvesting and good preservation of the graft and skilled transplantation are also very important. (4) reactive antibodies should be monitored.(5) alert attention should be called to the proper use and prompt regulation of the immunosuppresives. The use of steroid ought be minimized. The blood CsA level should be monitored. (6) monoclone and polyclone antibodies to T cell are the most effective immumosuppresives for steroid resistant acute rejection. (7) prevention and adequate treatment of infection are important as it is the most frequent cause of transplantation failure.(8) color Dopplar and ECT are very useful in diagnosing acute rejection.(9) postoperative follow up and management are imperative for long term allograft survival.
出处
《中华泌尿外科杂志》
CAS
CSCD
北大核心
1998年第2期76-79,共4页
Chinese Journal of Urology
