Albrechtsen D, Leivestad T, Brekke I, Fauchald P, Pfeffer P, Thorsby E
Rikshospitalet, University Hospital, Oslo, Norway.
Transplant Proc. 2004 Mar;36(2 Suppl):89S-93S. doi: 10.1016/j.transproceed.2004.01.026.
Following the introduction of cyclosporine as basic immunosuppression in our national transplant programme in 1983, the pool of grafts from living donors (LDs) was expanded 2 years later by also accepting LDs mismatched for 2 HLA haplotypes and living unrelated donors (LURDs), mostly spouses. A policy of approaching family members to promote donation was consistently pursued. During 1983 through 2002, nephrectomy was performed on 1519 LDs without mortality. From 1983 through 1988, our learning phase in managing cyclosporine-immunosuppression, 382 patients received first grafts from LDs. One-year graft survival (GS) rates were 94.4%, 90%, 89%, and 82% in 71 HLA identical, 260 haploidentical, 18 2-haplotypes disparate, and 33 LURD graft recipients, respectively. Corresponding half-lives were 15.8, 10.3, 11, and 9.1 years, respectively. Results improved in 1028 patients receiving first LD grafts from 1989 through 2002. Corresponding 1-year GS rates were 96.6% (n=117), 93.5% (n=650), 90.4% (n=73), and 88.8% (n=188), and half-lives were 30, 13.3, 13.5, and 12.3 years, respectively. Similar GS rates were observed in 109 recipients of repeat grafts from LDs. LDs contributed 44% and 21.6% of all first and repeat grafts transplanted, providing grafts to 11 patients (in 1983) increasing to 23 patients (in 2002) per million population per year (pmp/y). When added to grafts from cadaveric donors, 40 to 48 pmp/y were provided with a first or repeat graft since 1990, thus covering at least 65% of the national need for kidney transplantations.
1983年，环孢素被引入我国全国性移植项目作为基础免疫抑制剂，两年后，活体供者（LD）的供肾库得以扩大，开始接受2个HLA单倍型不匹配的LD以及活体非亲属供者（LURD，大多为配偶）。我们始终坚持向家庭成员宣传推广器官捐献的政策。1983年至2002年期间，对1519名LD进行了肾切除术，无一例死亡。1983年至1988年是我们管理环孢素免疫抑制的学习阶段，382例患者首次接受来自LD的肾移植。71例HLA全相同、260例单倍型相同、18例2个单倍型不同以及33例LURD肾移植受者的1年移植肾存活率（GS）分别为94.4%、90%、89%和82%。相应的移植肾半衰期分别为15.8年、10.3年、11年和9.1年。1989年至2002年期间，1028例首次接受LD肾移植的患者结果有所改善。相应的1年GS分别为96.6%（n = 117）、93.5%（n = 650）、90.4%（n = 73）和88.8%（n = 188），半衰期分别为30年、13.3年、13.5年和12.3年。109例接受来自LD再次移植的受者也观察到了相似的GS。LD提供了所有首次移植和再次移植肾的44%和21.6%，每年每百万人口中接受移植的患者从1983年的11例增加到2002年的23例（pmp/y）。自1990年起，加上尸体供者的肾移植，每年每百万人口中有40至48例接受首次或再次移植，从而至少满足了全国65%的肾移植需求。
