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米兰大学医院25年的移植经验。

Twenty-five years of transplant experience at Policlinico University Hospital of Milan.

作者信息

Berardinelli L, Vegeto A

机构信息

Polilinico University Hospital, Vascular Surgery and Kidney Transplantation Unit, Milano, Italy.

出版信息

Clin Transpl. 1994:243-53.

PMID:7547546
Abstract
  1. CsA treatment played a major role in the improvement of renal transplantation in the third era of our experience for every class of recipient. Many of the most recent patients involved higher risks than in previous eras. 2. The type of donor (LD or CD) did not make a significant difference in patient or graft survival rates up to 4 years. However, the survival rate of LD kidney transplants was better in later follow-ups than that of CD transplants. Pediatric and older kidneys can be used safely, although a lower survival rate is achieved by these grafts. 3. The sex and the side (right or left) of the donor kidney does not affect the outcome of transplantation. 4. In both multiorgan and single-kidney donor origin, there was no difference in graft survival. As all MOD kidneys were flushed with UW Solution and all SKD kidneys were flushed with EC Solution, we can assume that there is no difference in graft outcome, whichever of these solutions is employed. 5. The limited availability of CD grafts has been overcome by using marginal kidneys and adopting extracorporeal microvascular techniques. The results compared well with those of normal allografts. 6. The transplant outcome is penalized by expected higher mortality in older patients. And in pediatric patients there is a higher rate of graft failure due to rejection. 7. Retransplanted grafts under CsA have a better success rate than those using conventional therapy. 8. Extrarenal pathology and the actual risk ratio for CsA-treated recipients still need to be defined by future follow-ups. 9. Our results in renal transplantation, particularly from CDs, could be defined as good in comparison to those of other large transplant centers. 10. The main problem remains that the supply of CD kidneys has decreased in recent years, whereas the demand is increasing, perhaps due to the opening of other transplant centers, an inadequate policy for organ procurement, and ineffective legislation, the last being essential to promote kidney transplantation.
摘要
  1. 在我们经验的第三个阶段,环孢素A(CsA)治疗对各类受者肾移植的改善起到了主要作用。与之前各阶段相比,许多最新的患者面临更高的风险。2. 供体类型(活体供体或尸体供体)在4年内对患者或移植物存活率没有显著差异。然而,在后期随访中,活体供肾移植的存活率高于尸体供肾移植。儿科供肾和老年供肾可以安全使用,尽管这些移植物的存活率较低。3. 供肾的性别和侧别(右侧或左侧)不影响移植结果。4. 多器官供体和单肾供体来源的移植物存活率没有差异。由于所有多器官供肾均用UW液冲洗,所有单肾供肾均用EC液冲洗,我们可以假设,无论采用哪种溶液,移植物结果没有差异。5. 通过使用边缘供肾和采用体外微血管技术,克服了尸体供肾可用性有限的问题。结果与正常同种异体移植的结果相当。6. 老年患者预期的较高死亡率会影响移植结果。而在儿科患者中,由于排斥反应导致移植物失败的发生率较高。7. CsA治疗下的再次移植移植物成功率高于使用传统疗法的移植物。8. 肾外病理学以及CsA治疗受者的实际风险比仍需通过未来的随访来确定。9. 与其他大型移植中心相比,我们的肾移植结果,尤其是尸体供肾移植的结果,可以说是良好的。10. 主要问题仍然是,近年来尸体供肾的供应减少,而需求却在增加,这可能是由于其他移植中心的开设、器官获取政策不完善以及立法无效,最后一点对于促进肾移植至关重要。

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1
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Clin Transpl. 1994:243-53.
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