技术因素和不同免疫抑制方案对肾移植存活的影响。对300例肾移植进行回顾性分析。

Influence of technical factors and different immunosuppressive regimens on kidney graft survival. Retrospective analysis on 300 kidney transplants.

作者信息

Belli L, Minetti L, Civati G, Belli L S, Del Favero E, Seveso M, Brando B, Rondinara G, Broggi M L, Brunati C

出版信息

Ital J Surg Sci. 1985;15(4):323-8.

Abstract

300 patients underwent kidney transplantation. Uretero-neocystostomy was performed by means of the Politano-Leadbetter technique in the first 185 patients and direct ureterovesical anastomosis in the other 115 patients. Immunosuppression included conventional therapy (steroids, antilymphocyte globulins, azathioprine) and the association cyclosporine A and steroids. Retrospective analysis on these 300 patients indicates that the improved 1 year graft survival rate (85% vs 64%) we observed in the latest years has depended to the same extent, on improved surgical technique and on advent of cyclosporine A in our therapeutic protocols. Cyclosporine A at low starting doses immediately adjusted on whole blood trough levels (200-400 ng/ml) proved to be superior to other therapeutic schedules reported in this study (1-year graft survival rate: 94% vs 84%-73%). Direct ureterovesical anastomosis was characterized by a net reduction of urologic complications (2.5% vs 9.7%).

摘要

300例患者接受了肾移植。前185例患者采用波利塔诺-利德贝特技术进行输尿管膀胱吻合术，其余115例患者采用直接输尿管膀胱吻合术。免疫抑制包括传统疗法（类固醇、抗淋巴细胞球蛋白、硫唑嘌呤）以及环孢素A与类固醇联合使用。对这300例患者的回顾性分析表明，我们近年来观察到的移植肾1年存活率提高（85%对64%）在相同程度上既依赖于手术技术的改进，也依赖于环孢素A在我们治疗方案中的出现。起始剂量较低并根据全血谷浓度立即调整（200 - 400 ng/ml）的环孢素A被证明优于本研究中报告的其他治疗方案（移植肾1年存活率：94%对84% - 73%）。直接输尿管膀胱吻合术的特点是泌尿系统并发症明显减少（2.5%对9.7%）。