Wyner L M, Novick A C, Hodge E E, Flechner S M, Sankari B R, Streem S B
Department of Urology, Cleveland Clinic Foundation, Ohio, USA.
World J Urol. 1996;14(4):265-7. doi: 10.1007/BF00182078.
This report examines the long-term results obtained in 50 patients transplanted between 1977 and 1990 with kidneys from cadaveric donors aged 55-70 (median 59) years. The recipients comprised 27 men and 23 women aged 8-68 (median 42) years. In all, 20 patients (40%) had end-stage renal disease on the basis of glomerulonephritis, whereas 8 (16%) were diabetic. Immunosuppression was induced with antilymphocyte globulin and maintained with azathioprine and prednisone in all patients in addition to cyclosporine in the 35 patients transplanted since 1985. Immediate graft function occurred in 18 patients (36%), and 36 patients (72%) were off dialysis at 1 year posttransplant. Altogether, 25 patients (50%) had functioning grafts at 5 years posttransplant, and at up to 13 years of follow-up (mean 5.8 years), 22 patients (44%) are off dialysis and their serum creatinine levels range from 0.8 to 3.8 mg/dl (mean 2.0 mg/dl). In all, 12 patients (24%) expired from 2 months to 15.5 years posttransplant (mean 4.3 years), and 5 of these patients died with functioning grafts. These 5 deceased recipients and the 22 who remain alive with functioning grafts had a mean antigen match of 2.27 with their donors. The other 23 patients whose grafts failed had a mean antigen match of 2.13 (P = 0.77). The 15 recipients who were transplanted prior to the cyclosporine era had lower 1- and 5-year allograft survival rates of 67% and 47%, respectively, as compared with their counterparts, who took cyclosporine-based immunosuppression (74% and 51%, P = 0.58 and 0.76, respectively). Likewise, the 32 recipients with delayed graft function had lower 1- and 5-year allograft survival rates of 66% and 47%, respectively, as compared with the group with immediate graft function (83% and 56%, P = 0.18 and 0.56, respectively). We conclude that acceptable long-term patient and graft survival may be achieved by transplanting these organs and that the degree of HLA matching does not affect their outcome significantly. Patients with immediate allograft function also tended to do better over the long term. Although cyclosporine-based immunosuppression was advantageous within 1 year of transplant, its beneficial effect was less marked 5 years out.
本报告研究了1977年至1990年间50例接受移植的患者的长期结果，这些患者接受的是年龄在55至70岁（中位数59岁）的尸体供者的肾脏。受者包括27名男性和23名女性，年龄在8至68岁（中位数42岁）之间。总共有20例患者（40%）因肾小球肾炎发展为终末期肾病，而8例（16%）为糖尿病患者。所有患者均使用抗淋巴细胞球蛋白诱导免疫抑制，并使用硫唑嘌呤和泼尼松维持，1985年以来接受移植的35例患者还加用了环孢素。18例患者（36%）移植后立即出现移植肾功能，36例患者（72%）在移植后1年停止透析。总共有25例患者（50%）在移植后5年移植肾功能良好，在长达13年的随访期（平均5.8年）内，22例患者（44%）停止透析，血清肌酐水平在0.8至3.8mg/dl之间（平均2.0mg/dl）。总共有12例患者（24%）在移植后2个月至15.5年（平均4.3年）死亡，其中5例患者死亡时移植肾功能良好。这5例已故受者和22例移植肾功能良好存活的受者与其供者的平均抗原匹配度为2.27。另外23例移植失败的患者平均抗原匹配度为2.13（P=0.77）。在环孢素时代之前接受移植的15例受者1年和5年的同种异体移植存活率分别为67%和47%，低于接受以环孢素为基础的免疫抑制的对应患者（74%和51%，P分别为0.58和0.76）。同样，32例移植肾功能延迟的受者1年和5年的同种异体移植存活率分别为66%和47%，低于移植后立即出现移植肾功能的患者组（83%和56%，P分别为0.18和0.56）。我们得出结论，移植这些器官可以实现可接受的患者和移植肾长期存活率，HLA匹配程度对其结果没有显著影响。移植后立即出现移植肾功能的患者长期来看往往情况更好。虽然以环孢素为基础的免疫抑制在移植后1年内具有优势，但其有益效果在5年后不太明显。
