Suranyi M G, Hall B M
Department of Medicine, Stanford University Medical Center, CA 94305-5114.
West J Med. 1990 Jun;152(6):687-96.
The success rate of renal transplantation has improved considerably during the past decade, with substantial improvements in both graft and patient survival. The quality of graft function, however, and not graft survival alone is increasingly determining the standards by which transplantation outcome is being judged. As the demand for kidney transplants continues to rise and transplants are being offered to an ever-increasing number of patients, organs are being sought from new supply pools and efforts are being made to use current resources more efficiently. Improvements in clinical management have allowed short-term complications such as infection and rejection to be better prevented or better diagnosed and treated. Fundamental advances in the understanding of the immunologic processes underlying both allograft rejection and acceptance and the introduction of new immunosuppressive agents have allowed a better use of drug therapy and have moved the goal of acquired transplant tolerance closer to attainment. With improved initial transplant success rates, the long-term transplantation outcome is becoming more important. The role of tissue matching in preventing chronic rejection is becoming more appreciated, and the long-term risks of malignancy, arteriosclerosis, and chronic rejection are being better recognized and managed.
在过去十年中，肾移植的成功率有了显著提高，移植物和患者的存活率都有了大幅提升。然而，决定移植结果评判标准的，越来越不仅仅是移植物的存活情况，移植物功能的质量也日益重要。随着肾移植需求持续上升，接受移植的患者数量不断增加，人们开始从新的供体库寻找器官，并努力更高效地利用现有资源。临床管理的改善使得感染和排斥等短期并发症能够得到更好的预防、诊断和治疗。在对同种异体移植物排斥和接受所涉及的免疫过程的理解方面取得的根本性进展，以及新免疫抑制剂的引入，使得药物治疗得到了更好的应用，并使实现获得性移植耐受的目标更接近达成。随着初始移植成功率的提高，长期移植结果变得越发重要。组织配型在预防慢性排斥中的作用越来越受到重视，恶性肿瘤、动脉硬化和慢性排斥的长期风险也得到了更好的认识和管理。
