中国组织工程研究

中国组织工程研究 ›› 2011, Vol. 15 ›› Issue (18): 3271-3275.doi: 10.3969/j.issn.1673-8225.2011.18.011

• 肾移植 kidney transplantation • 上一篇    下一篇

再次肾移植疗效评价及预后多因素分析

赵于军1，2，成  柯1，2，明英姿1，2，刘  炼1，2，刘  洪1，2，佘兴国1，2，叶启发1，2   

  1. 1中南大学湘雅三医院湘雅移植医学研究院，湖南省长沙市 410013
    2卫生部移植医学工程技术研究中心，湖南省长沙市  410013
  • 收稿日期:2010-11-03 修回日期:2011-03-28 出版日期:2011-04-30 发布日期:2011-04-30
  • 通讯作者: 叶启发，主任医师，中南大学湘雅三医院湘雅移植医学研究院，湖南省长沙市 410013；卫生部移植医学工程技术研究中心，湖南省长沙市 410013 yqf_china@163.com
  • 作者简介:赵于军☆，男，1973年生，湖南省桃源县人，汉族，2006年中南大学毕业，博士，主治医师，主要从事肝肾移植临床及基础的研究。 zyjdoc@yahoo.com.cn

Therapeutic outcomes evaluation and multi-factor prognostic analysis of renal retransplantation

Zhao Yu-jun1,2, Cheng Ke1,2, Ming Ying-zi1,2, Liu Lian1,2, Liu Hong1,2, She Xing-guo1,2, YE Qi-fa1,2   

  1. 1Xiangya Transplantation Medical Academy, Third Xiangya Hospital, Central South University, Changsha  410013, Hunan Province, China
    2Research Center of Transplantation Medicine Engineering and Technology, Ministry of Health, Changsha  410013, Hunan Province, China
  • Received:2010-11-03 Revised:2011-03-28 Online:2011-04-30 Published:2011-04-30
  • Contact: Ye Qi-fa, Chief physician, Xiangya Transplantation Medical Academy, Third Xiangya Hospital, Central South University, Changsha 410013, Hunan Province, China; Research Center of Transplantation Medicine Engineering and Technology, Ministry of Health, Changsha 410013, Hunan Province, China yqf_china@163.com
  • About author:Zhao Yu-jun☆, Doctor, Attending physician, Xiangya Transplantation Medical Academy, Third Xiangya Hospital, Central South University, Changsha 410013, Hunan Province, China; Research Center of Transplantation Medicine Engineering and Technology, Ministry of Health, Changsha 410013, Hunan Province, China zyjdoc@yahoo.com.cn

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摘要：

背景：随着新型免疫抑制的使用和围手术期处理水平的提高，再次肾移植疗效已得到很大提高，然而与首次移植相比，再次肾移植面临更多的危险因素。
目的：评价再次肾移植的疗效，分析影响预后的主要因素。
方法：回顾分析中南大学湘雅三医院湘雅移植医学研究院2001-04/2009-06再次肾移植患者68例的临床资料，用Kaplan-Meier法计算人/肾存活率并与同期首次移植患者的人/肾存活率对比分析，选用可能影响再次肾移植疗效的12个临床指标，Log-rank检验和Cox回归模型分别进行预后单因素和多因素分析。
结果与结论：全组随访6~86个月，随访期间死亡10例(14.7%)，移植肾失功18例(26.5%)。再次移植组1，3，5年人/肾存活率分别为94.1%/89.7%，87.3%/80.5%，80.3%/68.7%，对照组为96.3%/94.5%，90.5%/85.4%，83.8%/75.6%，再次肾移植人/肾存活率均低于首次移植，但差异无显著性意义(P > 0.05)。单因素分析显示，首次移植肾存活时间、群体反应性抗体峰值、HLA抗原错配、急性排斥、移植肾功能延迟恢复和免疫诱导与再次移植肾存活有关；COX回归多因素分析显示，首次移植肾存活时间、群体反应性抗体峰值和HLA抗原错配是影响移植肾存活的独立因素。随着再次肾移植前后处理水平的提高，再次移植可获得与首次移植近似的疗效；首次移植肾存活时间、群体反应性抗体峰值和HLA抗原错配是影响再次肾移植预后的最主要因素。

关键词: 再次肾移植, 移植物, 存活, 影响因素, 器官移植, 预后

Abstract:

BACKGROUND: Renal retransplantation has more benefits of used new immunosuppressive agents and improved perioperative management; however, compared with the primary allografts, regrafts face more risk factors. With the shortage of renal donations, it is necessary to assess long-term outcome of regrafts and to identify risk factors associated with long-term graft survial.
OBJECTIVE: To evaluate the therapeutic outcomes of renal retransplantation and analyze the prognostic factors.
METHODS: The clinical and follow-up data of 68 patients who underwent renal retransplantation between April 2001 and June 2009 in Xiangya Transplantation Medical Academy of the Third Xiangya Hospital of Central South University were analyzed retrospectively. The patient/graft survival rates were calculated by Kaplan-Meier method and compared to primary ones performed during the same period. A total of 12 clinical indictors were selected, Log-rank test and Cox proportional hazards regression model were performed to analyze prognostic factors of regraft outcome.
RESULTS AND CONCLUSION: The follow-up time ranged from 6 to 86 months (median, 38.6 months). The mortality was 14.7%, The regraft loss rate was 26.5%. Survival rates at 1-, 3- and 5-year of the patient/graft of retransplantation group were 94.1%/89.7%, 87.3%/80.5% and 80.3%/68.7% respectively，while those at 1-, 3- and 5- years of the patient/graft of the primary renal transplantation were 96.3%/94.5%, 90.5%/85.4% and 83.8%/75.6%, respectively. No significant difference in the patient/graft survival rates was observed between two groups (P > 0.05). Univariate analysis showed that the duration of primary graft survival, peak panel reactive antibody (PRA) level, HLA mismatch，acute rejection, delayed graft function (DGF) and induction therapy were significantly associated with regraft survival. Multivariate Cox regression analysis showed that the duration of primary graft survival, peak PRA level and HLA mismatch were independent prognostic factors of regraft.The regraft had more benefits of improved pre-transplant screening and post-transplant management, and its survival rate was satisfactory and similar to that of primary one. The duration of primary graft survival, peak PRA level and HLA mismatch are main determinants of regraft outcome.

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