早期移植肾功能异常的相关因素及其预后.docVIP

???? 早期移植肾功能异常的相关因素及其预后 ???? ????　【摘要】　目的　探讨早期移植肾功能异常的相关因素及其对移植肾长期存活的影响。方法　根据术后6个月内有无发生急性排斥反应和6个月时的血肌酐水平(SCr6月)，将251例肾移植患者分为4组：A、B组未发生急性排斥反应，前者SCr6月＜130 μmol/L，后者SCr6月≥130 μmol/L；C、D组发生急性排斥反应，前者SCr6月＜130 μmol/L，后者SCr6月≥130 μmol/L。术后各组的免疫抑制方案相同。结果　4个组在冷缺血及热缺血时间、受者的年龄及淋巴细胞毒交叉配合试验的差异不显著；A、C组术后10天时的血肌酐水平(SCr10天)一直保持正常，B、D组的SCr10天明显升高；SCr10天升高与急性肾小管坏死、IgA供肾、供者的年龄、术中低血压、急性排斥反应的次数及环孢素A的用量相关；A、B及C组间术后移植肾1年、3年存活率的差异不显著，D组移植肾的1年、3年存活率明显低于A、B、C组。结论　急性肾小管坏死是早期移植肾功能异常最常见的原因；取肾过程的损伤、再灌注及早期大剂量使用环孢素A可影响早期移植肾功能的恢复；术后6个月内发生过急性排斥反应者，若其术后早期移植肾功能异常，往往影响移植肾的长期存活。　　【关键词】　肾/移植　　肾功能试验　　特殊物生存 Correlation factors for early graft dysfunction and prognosis after cadaver renal transplantation JI Shuming, YIN Guang, YIN Liping, et al.Nanjing General Hospital of Nanjing Command of PLA, Nanjing 210002 　　【Abstract】　Objective　To investigate the correlation factors for early graft dysfunction after kidney transplantation, and the effects on long-term graft survival. Methods　251 recipients of first cadaver renal graft were divided into 4 groups according to the history of acute rejection (AR) and the concentration of serum creatinine (SCr) in 6 months after transplantation: Groups A and B, having no history of AR with SCr levels at 6th month of ＜130 μmol/L in the former and ≥130 μmol/L in the latter, and groups C and D having the history of AR with SCr levels at 6 th month of ＜130 μmol/L in the former and ≥130 μmol/L in the latter. All groups had the same immunosuppressive protocol. Results　SCr level at 10th day after operation in groups A and C maintained normal, while the SCr levels in groups B and D were obviously elevated, which was correlated with acute tubular necrosis (ATN), IgA nephritis, donors age, postoperative hypotension, AR times and the dosage of cyclosporine A. The one-and three-year survival rate of renal graft in groups D was significantly lower than in groups A, B and C. Conclusion　ATN was the commonest cause for early renal graft dysfunction after renal transplantation. The dam