Frei U, Brunkhorst R, Schindler R, Bode U, Repp H, Pichlmayr R, Koch K M
Department of Nephrology, Medizinische Hochschule Hannover, Germany.
Clin Nephrol. 1992;38 Suppl 1:S46-52.
Kidney transplantation today is the method of choice to treat end-stage renal disease (ESRD) in more than 50% of the ESRD-population. Due to major improvements in surgical handling, immunosuppressive therapy, and infection control, the one-year survival for patients and first grafts has reached nearly 90% in the recent years. In contrast no comparable achievements have been made in long-term graft survival. A constant number of grafts is lost yearly after the first postoperative year. In addition an increasing number of well functioning grafts is lost due to the death of the recipients caused mainly by cardiovascular and malignant disorders. The extension of kidney transplantation to all suitable recipients is nearly exclusively hampered by the organ shortage, which is further enhanced by failing grafts. This urges us to further improve the prognosis for patient and graft. This must include organ sharing on the basis of improved HLA-typing to achieve highly compatible grafts. The tools for differential diagnosis of acute and chronic graft dysfunction have to be improved. New immunosuppressive agents with higher immunosuppressive power and specificity but fewer nephrotoxic, metabolic and hemodynamic side effects are required at least for chronic rejection. The risk of infectious and malignant complications must be limited.
如今，肾移植是治疗超过50%的终末期肾病（ESRD）患者的首选方法。由于手术操作、免疫抑制治疗和感染控制方面的重大改进，近年来患者和首次移植肾的一年生存率已接近90%。相比之下，在长期移植肾存活方面尚未取得类似的成果。术后第一年之后，每年都有一定数量的移植肾丧失功能。此外，由于受者主要因心血管疾病和恶性疾病死亡，越来越多功能良好的移植肾也因此丧失。将肾移植扩展至所有合适受者几乎完全受到器官短缺的阻碍，而移植肾失功又进一步加剧了这一问题。这促使我们进一步改善患者和移植肾的预后。这必须包括在改进的HLA分型基础上进行器官分配，以获得高度匹配的移植肾。急性和慢性移植肾功能障碍的鉴别诊断工具也有待改进。至少对于慢性排斥反应，需要具有更高免疫抑制效力和特异性、但肾毒性、代谢和血流动力学副作用更少的新型免疫抑制剂。感染和恶性并发症的风险必须加以控制。
