Strom T B
Am J Med. 1982 Jul;73(1):105-24. doi: 10.1016/0002-9343(82)90937-8.
The results achieved by treating patients with end-stage renal failure with allotransplantation have improved dramatically since the 1950s when immunosuppression was induced by total body irradiation and there was a lack of HLA typing. Although long-term hemodialysis offers prolonged survival and partial rehabilitation for many individuals with end-stage renal disease, the technique is inconvenient and time consuming. Patients are restricted by necessary proximity to the machine, dietary limitations, potential failure of access sites, and complications of various organ systems. Despite the availability of dialysis and the federal funds to partially pay for treatment, long-term dialysis still remains a costly process for the individual in need of care. During the same period when dialysis techniques improved and became widely available, transplantation of the human kidney became an established and justified treatment for some patients with end-stage renal disease. Those with successful kidney allografts may achieve remarkable recovery and are often able to return to normal lives. One of the more striking improvements in the results of renal transplantation in recent years had been the decline in morbidity and mortality. Mortality by the end of the first year after transplantation during which time most deaths occur, is currently less than 5 percent in a number of major medical units. In part, this decline represents a change in philosophy by transplant teams, who now tend to decrease immunosuppression and sacrifice the kidney rather than the patient in instances of inexorable rejection. In addition, declining mortality is directly attributable to improved methods of preventing, discovering, and treating patients with potential or real infections. More recently, in some centers, the rate of successful engraftment has shown gratifying improvement due to refinements in tissue typing, improved cross matching, new immunosuppressive therapies, and pretransplant conditioning with blood products. These recent improvements are the primary focus of this review. Unfortunately, until very recently, rates of functional survival of allografts have not been satisfactory.
自20世纪50年代以来，同种异体移植治疗终末期肾衰竭患者所取得的成果有了显著改善。当时，免疫抑制是通过全身照射诱导的，且缺乏HLA分型。尽管长期血液透析能延长许多终末期肾病患者的生存期并使其部分康复，但该技术不便且耗时。患者受到必须靠近机器、饮食限制、血管通路部位可能出现故障以及各种器官系统并发症的限制。尽管有透析可用，且联邦资金可部分支付治疗费用，但长期透析对需要护理的个人来说仍然是一个昂贵的过程。在透析技术得到改进并广泛应用的同一时期，人类肾脏移植成为一些终末期肾病患者既定且合理的治疗方法。那些肾移植成功的患者可能会实现显著康复，并且通常能够回归正常生活。近年来肾移植结果中较为显著的一项改善是发病率和死亡率的下降。在移植后的第一年内，大部分死亡发生在此期间，目前一些主要医疗单位的死亡率低于5%。部分而言，这种下降代表了移植团队理念的转变，他们现在倾向于在不可避免的排斥情况下减少免疫抑制，并舍弃肾脏而非患者。此外，死亡率的下降直接归因于预防、发现和治疗潜在或实际感染患者的方法得到改进。最近，在一些中心，由于组织配型的改进、交叉配型的改善、新的免疫抑制疗法以及用血制品进行移植前预处理，成功移植率有了令人满意的提高。这些近期的改进是本综述的主要关注点。不幸的是，直到最近，同种异体移植物的功能存活比率一直不尽人意。
