Xiao Xuren, Ao Jianhua, Lu Jinshan, Hong Baofa, Ye Linyang, Zhang Lei, Wei Cai, Gao Jiangping, Yang Yong, Dong Jun, Wang Xiaoxiong, Li Yantang, Xu Dianyi
Department of Urology, Chinese People's Liberation Army General Hospital, Postgraduate Medical School, Beijing, China.
Clin Transpl. 2005:187-97.
Between October 1977 and December 2004, 2,037 kidney transplants were performed in 1,804 patients with ESRD at the Peoples Liberation Army General Hospital Postgraduate Medical School. Overall graft survival rates at one, 5, 10, 15, and 20 years were 91.6%, 79.3%, 64.3%, 53.8%, and 47.6%, respectively. The number of transplants significantly increased during the past decade. One-year patient and graft survival rates have increased from 40% and 35% in the 1970s to 98% and 96% in the 2000s, respectively. Since CSA was introduced to our clinic, one-year graft survival rates have increased from 33% to 93% and the half-lives have significantly improved from 13.1 years to 21.7 years. Also, the graft survival rate for patients on CSA-based triple therapy using MMF was about 18% higher at 5 years than those for patients using AZA (92% vs. 74%, p < 0.001), and 11% higher at 10 years (71% vs. 60%, p < 0.01). Our analysis showed that transplant year, DGF, rejection, immunosuppressive regimen, ABO blood group, and original disease were independent factors impacting on graft survival and poor HLA matching with 5-6 mismatches had an adverse effect on graft survival compared with 1-2 mismatches. Infection, cardio- and cerebral accidents and hepatic failure were the 3 main causes of death in transplant recipients.
1977年10月至2004年12月期间，解放军总医院研究生院对1804例终末期肾病患者实施了2037例肾移植手术。移植肾1年、5年、10年、15年和20年的总体存活率分别为91.6%、79.3%、64.3%、53.8%和47.6%。在过去十年中，移植手术数量显著增加。患者和移植肾的1年存活率分别从20世纪70年代的40%和35%升至21世纪初的98%和96%。自从我院临床应用环孢素A以来，移植肾1年存活率从33%升至93%，半衰期也从13.1年显著提高到21.7年。此外，接受以环孢素A为基础、联合霉酚酸酯的三联免疫抑制治疗的患者，其移植肾5年存活率比接受硫唑嘌呤治疗的患者高约18%（92%对74%，p<0.001），10年存活率高11%（71%对60%，p<0.01）。我们的分析表明，移植年份、移植肾功能延迟恢复、排斥反应、免疫抑制方案、ABO血型以及原发病是影响移植肾存活的独立因素，与1-2个错配相比，5-6个错配的不良人类白细胞抗原配型对移植肾存活有不利影响。感染、心脑血管意外和肝衰竭是移植受者的3个主要死亡原因。
