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目的：分析肾移植后免疫抑制剂对长期存活的影响，寻找移植后不同时间合适的免疫抑制用药方案及其用药剂量。方法：对肾移植一年以上、肾功能正常的４９７例患者进行５年连续随访。根据移植后２、３、５年的不同免疫抑制用药将患者分为三联、二联、传统二联治疗三组。统计各组的排异发生率，排异和无排异患者免疫抑制用药的种类、剂量及ＣｓＡ浓度，对排异患者追踪排异发生前１２个月内的药物更动情况。结果：肾移植后２、３、５年的三联治疗排异率分别为４．９４％、４．９３％和５．６５％。传统二联治疗为７．６９％、１２．３５％和５．１０％。三联治疗的排异发生率明显低于传统二联治疗（Ｐ＜０．０５）。绝大多数排异患者有ＣｓＡ或Ａｚａ停药或减量史。结论：肾移植后三联治疗是维持治疗的最佳方案，停用或减少ＣｓＡ是导致排异发生的主要原因。
OBJECTIVE: To analyze the effect of immunosuppressive agents on the long-term survival after kidney transplantation and to find suitable immunosuppressive drug regimens and dosage at different time after transplantation. Methods: 497 consecutive patients with more than one year of renal transplantation and normal renal function were followed up for 5 years. According to 2, 3, 5 years after transplantation, different immunosuppressive drugs were divided into three groups, two groups and two groups. The incidence of rejection, the type, dose and CsA concentration of immunosuppressive drugs in patients with rejection and non-rejection were counted, and the changes of drugs within 12 months before rejection were followed up. Results: The triple therapy rates at 2, 3 and 5 years after renal transplantation were 4.94%, 4.93% and 5.65%, respectively. Traditional dual therapy was 7.69%, 12.35% and 5.10%. The incidence of triple therapy was significantly lower than the traditional two-way treatment (P <0.05). The vast majority of patients with abnormal CsA or Aza withdrawal or reduction history. CONCLUSION: Triple therapy after kidney transplantation is the best choice for maintenance therapy. Discontinuation or reduction of CsA is the main reason leading to rejection.