Denisov Viktor K, Zakharov Vadim V, Onishchenko Eugeny V, Golubova Tatyana S, Mitsuk Yana G, Zakharova Olga V
From the Transplant Center, Regional Clinical Hospital, Donetsk, Ukraine.
Exp Clin Transplant. 2015 Apr;13 Suppl 1:228-30.
To show the effects of different factors on development and outcome of early kidney allograft dysfunction.
Two hundred thirty-one kidney transplant recipients were divided into 2 groups: group 1 (125 patients transplanted from 1999-2004) and group 2 (106 patients transplanted from 2008-2013). Age range was 12 to 62 years (group 1) and 7 to 71 years (group 2). Deceaseddonor transplant was more frequent in group 1 (76.8%), and living-donor transplant in group 2 (68.8%). In group 1, transplant was performed for glomerulonephritis or pyelonephritis; in group 2, additional risk factors (18 patients) included diabetes (11 patients), systemic lupus erythematosus (5 patients), amyloidosis (1 patient), and aortic and mitral valve replacement because of bacterial endocarditis (1 patient). In groups 1 and 2, immunosuppression after transplant included cyclosporine, mycophenolate mofetil, and steroids; patients in group 2 also had induction with anti-CD25 monoclonal antibodies.
Primary graft function occurred in 89 patients in group 1 (71.2%) and 83 patients in group 2 (78.3%). Immediately after transplant, delayed graft function included anuria, oliguria, adequate amount of urine, and secondary delayed function (several days of polyuria followed by decreased urine output). Ischemia was a leading cause of delayed renal graft function. Anuria after living-donor transplant was a sign of vascular thrombosis. Rejection was the main cause of secondary delayed graft function, which occurred in only group 1. Survival at 1 year in patients with delayed graft function was 80% in group 1 and 100% in group 2 because of the absence of septic complications.
Despite extension of indications, primary functioning of kidney transplants and patient survival increased. Improved care enables long-term rehabilitation of recipients and expanding criteria for kidney transplant.
展示不同因素对早期肾移植功能障碍的发展及转归的影响。
231例肾移植受者被分为两组：第1组（125例，于1999年至2004年接受移植）和第2组（106例，于2008年至2013年接受移植）。年龄范围为12至62岁（第1组）和7至71岁（第2组）。第1组中尸体供者移植更为常见（76.8%），而第2组中活体供者移植更为常见（68.8%）。在第1组中，移植是因肾小球肾炎或肾盂肾炎而进行；在第2组中，额外的危险因素（18例患者）包括糖尿病（11例患者）、系统性红斑狼疮（5例患者）、淀粉样变性（1例患者）以及因细菌性心内膜炎而行主动脉和二尖瓣置换术（1例患者）。在第1组和第2组中，移植后的免疫抑制包括环孢素、霉酚酸酯和类固醇；第2组患者还使用抗CD25单克隆抗体进行诱导治疗。
第1组有89例患者（71.2%）发生原发性移植肾功能，第2组有83例患者（78.3%）发生原发性移植肾功能。移植后即刻，延迟移植肾功能包括无尿、少尿、尿量正常以及继发性延迟功能（数天多尿后尿量减少）。缺血是肾移植延迟功能的主要原因。活体供者移植后的无尿是血管血栓形成的征象。排斥反应是继发性延迟移植肾功能的主要原因，仅在第1组中出现。由于没有感染并发症，移植肾功能延迟患者的1年生存率在第1组为80%，在第2组为100%。
尽管适应证有所扩大，但肾移植的原发性功能及患者生存率有所提高。改善的护理使得受者能够长期康复，并扩大了肾移植的标准。
