Nephrology Institute, Havana, Cuba.
MEDICC Rev. 2013 Jan;15(1):23-8. doi: 10.37757/MR2013V15.N1.6.
This article describes the background, beginnings, development, evolution and outcomes of kidney transplantation in Cuba. Nephrology as a medical specialty in Cuba began in 1962 and was formalized in 1966. Conditions were created to implement renal replacement therapy (including transplants), bring nephrology care to the entire country and train human resources who would assume this responsibility, making Cuba one of the first countries with a comprehensive program for renal patient care. After three unsuccessful cadaveric-donor kidney transplantations in 1968-69, the ensuing history of kidney transplantation can be summarized in the following three stages. 1970-1975: In January 1970, cadaveric-donor kidney transplantation began at the Nephrology Institute. That year, 17 kidney transplantations were performed; four of these patients lived with functional kidneys for 15-25 years; 10-year graft survival was 23.5% (Kaplan-Meier survival curve); HLA typing began in 1974. By December 1975, 170 grafts had been done in three hospitals. 1976-1985: Seven transplantation centers performed 893 grafts during this period. HLA-DR typing was introduced in 1976 and the National Histocompatibility Laboratory Network was founded in 1978. The first related living-donor kidney transplantation was done in 1979. 1986-2011: The National Kidney Transplantation Coordinating Center and the National Kidney Transplantation Program were created in 1986; the first combined kidney-pancreas transplantation was performed the same year. In 1990, cyclosporine and the Cuban monoclonal antibody IOR-T3 were introduced for immunosuppression to prevent rejection, as were other Cuban products (hepatitis B vaccine and recombinant human erythropoietin) for transplant patients. By December 2011, the cumulative number of transplants was 4636 (384 from related living donors). With over 40 years of experience, kidney transplantation is now well established in Cuba; it is free and universally accessible, on the basis of need and appropriateness.
本文描述了古巴肾移植的背景、起源、发展、演变和结果。1962 年，肾脏病学作为医学专业在古巴开始发展，并于 1966 年正式确立。古巴创造了实施肾脏替代治疗（包括移植）的条件，将肾脏病护理带到全国，并培训了将承担这一责任的人力资源，使古巴成为第一个拥有全面肾脏患者护理计划的国家之一。在 1968-69 年进行了三次不成功的尸体供体肾移植后，接下来的肾移植历史可以总结为以下三个阶段。
1970-1975 年：1970 年 1 月，肾脏病研究所开始进行尸体供体肾移植。当年进行了 17 例肾移植，其中 4 例患者的功能性肾脏存活了 15-25 年；10 年移植物存活率为 23.5%（Kaplan-Meier 生存曲线）；1974 年开始进行 HLA 分型。截至 1975 年 12 月，三所医院共进行了 170 例移植。
1976-1985 年：在此期间，7 个移植中心共进行了 893 例移植。1976 年引入 HLA-DR 分型，1978 年成立国家组织相容性实验室网络。1979 年进行了首例相关活体供者肾移植。
1986-2011 年：1986 年创建了国家肾移植协调中心和国家肾移植计划；同年进行了首例联合肾胰脏移植。1990 年，环孢素和古巴单克隆抗体 IOR-T3 被引入用于免疫抑制以防止排斥反应，还有其他古巴产品（乙肝疫苗和重组人促红细胞生成素）也用于移植患者。截至 2011 年 12 月，累计移植数为 4636 例（来自相关活体供者的 384 例）。古巴有 40 多年的经验，肾移植现在已经在古巴得到很好的确立；它是免费的，普及的，基于需要和适当性。
