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目的对再次肾移植进行临床总结。方法回顾性分析86例再次移植患者的临床资料,并与86例首次肾移植患者进行对比分析。首次肾移植失败的原因,17例为超急性排斥反应,9例为急性排斥反应,55例为慢性移植肾肾病,4例为移植肾破裂,1例为严重肾结核;再次移植前,31例群体反应性抗体(PRA)或补体依赖细胞毒(CDC)阳性;再次移植后,16例采用泼尼松(Pred)和硫唑嘌呤(Aza)预防急性排斥反应,70例采用环孢素A(或他克莫司)、Aza(或霉酚酸酯)及Pred组成的三联用药方案,32例再次移植前后接受抗体诱导治疗。结果再移植组人/肾1、3和5年存活率分别为84.8%/61.6%、79.1%/45.3%和58.1%/41.9%,对照组分别为89.5%/79.1%、81.4%/74.4%和67.4%/58.1%,两组人存活率的差异无统计学意义,而各时间段的肾存活率的差异均有统计学意义(P<0.05);术前使用抗体诱导治疗者以及术后采用环孢素A(或他克莫司)预防排斥反应者移植肾1年存活率明显优于未用抗体诱导治疗者和仅用Aza、Pred治疗者;术后排斥反应发生率,再移植组明显高于首次移植组(P<0.05);再移植组术后感染发生率明显高于首次移植者。结论再次移植的肾存活率明显低于首次移植,术后排斥反应和感染的发生率较高;采用抗体诱导治疗有利于再移植肾的存活。
Objective To summarize the renal transplant again. Methods The clinical data of 86 patients with recanalization were retrospectively analyzed and compared with 86 patients with primary renal transplantation. The causes of the first failure of renal transplantation, 17 cases of hyperacute rejection, 9 cases of acute rejection, 55 cases of chronic renal allograft nephropathy, 4 cases of renal tuberculosis rupture and 1 case of severe renal tuberculosis; before re-transplantation, 31 cases (PRA) or complement-dependent cytotoxicity (CDC). After re-transplantation, prednisone (Pred) and azathioprine (Aza) were used in 16 patients to prevent acute rejection and 70 patients were treated with cyclosporine A Or tacrolimus), Aza (or mycophenolate mofetil) and Pred, and 32 patients received antibody induction therapy before and after transplantation. Results The 1, 3 and 5-year survival rates of the transplanted human / kidney were 84.8% / 61.6%, 79.1% / 45.3% and 58.1% / 41.9%, respectively, while those in the control group were 89.5% / 79.1% and 81.4% / 74.4% And 67.4% / 58.1%, respectively. There was no significant difference in survival rate between the two groups, but there was significant difference in the survival rate of the kidney between the two groups (P <0.05). Preoperative treatment with antibody and postoperative The 1-year survival rate of renal allografts with cyclosporine A (or tacrolimus) for rejection prevention was significantly better than those without antibody induction and with Aza and Pred alone; the incidence of postoperative rejection, Significantly higher than the first transplantation group (P <0.05); the incidence of postoperative infection in the retransplantation group was significantly higher than that of the first transplant. Conclusions The survival rate of renal allografts was significantly lower than that of primary transplantation. The incidence of postoperative rejection and infection was high. The induction of antibody therapy was beneficial to the survival of renal allografts.