Department of Nephrology, Kaunas University of Medicine, Eivenių 2, 50028 Kaunas, Lithuania.
Medicina (Kaunas). 2010;46(8):538-43.
During 10 years, 163 cadaveric kidney transplantations were performed at the Hospital of Kaunas University of Medicine. The aim of this study was to analyze the first 10-year experience in kidney transplantation and to evaluate the most frequent early and late complications after transplantation, graft and patient survival, and impact of delayed graft function on graft survival.
A total of 159 patients were included into the study. Graft and patient survival was calculated at 1, 3, and 5 years after transplantation using the Kaplan-Meier method; graft function was also analyzed.
Fifty-three patients (33.3%) in the early period and 72 (55.4%) in the late period had at least one episode of urinary tract infection. Less than half (47.2%) of patients had complications related to immunosuppressive treatment, mostly cytomegalovirus infection, in the late period. The risk of CMV reactivation was 3.98 times higher among recipients who received prophylaxis only with intravenous ganciclovir as compared to patients who received valganciclovir after a brief course of ganciclovir (OR, 3.98; 95% CI, 1.48-8.19; P=0.003). Delayed graft function was observed in 53 cases (33.3%); 37 (23.3%) grafts were lost. Graft and patient survival at 1, 3, and 5 years after transplantation was 85%, 82%, and 71% and 97%, 94%, and 94%, respectively. Graft survival at 1, 3, and 5 years was worse among patients with delayed graft function as compared to patients with good graft function (69%, 69%, 50% vs. 93%, 86%, 84%, respectively; P<0.05).
Urinary tract infection was the most frequent complication after kidney transplantation. Reactivation of cytomegalovirus infection was present only in a quarter of our patients. The administration of valganciclovir was associated with a significantly lower incidence of CMV infection/disease. Graft and patient survival was sufficiently good. Delayed graft function was an independent risk factor for worse graft survival.
在 10 年间，163 例尸体供肾移植在考纳斯医科大学医院进行。本研究旨在分析肾移植的首个 10 年经验，并评估移植后早期和晚期最常见的并发症、移植物和患者存活率，以及延迟移植物功能对移植物存活率的影响。
共纳入 159 例患者。使用 Kaplan-Meier 法计算移植后 1、3 和 5 年的移植物和患者存活率；还分析了移植物功能。
53 例（33.3%）患者在早期和 72 例（55.4%）患者在晚期至少有一次尿路感染。不到一半（47.2%）的患者在晚期出现与免疫抑制治疗相关的并发症，主要为巨细胞病毒感染。与仅接受静脉更昔洛韦预防的患者相比，接受短暂更昔洛韦治疗后使用缬更昔洛韦预防的患者 CMV 再激活的风险更高（OR，3.98；95%CI，1.48-8.19；P=0.003）。53 例（33.3%）患者发生延迟移植物功能；37 例（23.3%）移植物丢失。移植后 1、3 和 5 年的移植物和患者存活率分别为 85%、82%和 71%和 97%、94%和 94%。与移植物功能良好的患者相比，延迟移植物功能患者的移植物存活率在移植后 1、3 和 5 年时更差（分别为 69%、69%、50%与 93%、86%、84%；P<0.05）。
尿路感染是肾移植后最常见的并发症。我们的患者中只有四分之一出现巨细胞病毒感染再激活。使用缬更昔洛韦与 CMV 感染/疾病发生率显著降低相关。移植物和患者存活率足够好。延迟移植物功能是移植物存活率恶化的独立危险因素。
