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目的回顾中国人民解放军总医院近28年来的肾移植临床资料,分析探讨影响移植肾存活的危险因素和导致受者死亡的原因。方法 1977年10月至2004年12月,我院总共为1804例终末期肾病患者施行了2037例次肾移植手术。根据临床资料和截止2005年底的随访结果,采用Kaplan-Meier方法计算人、移植肾存活率,并按照Terasaki公式计算移植肾的半数生存期及其标准误对影响移植肾存活的诸因素以及受者的死亡原因进行单因素和多因素(Cox模型)分析,并以log-rank检验和t检验确定统计学意义。结果 1、5、10、15和20年移植肾总存活率分别为91.4%、79.0%、63.9%、53.3%和47.6%。近10年的移植数量显著增加,移植后1年人、移植肾存活率由70年代的40.0%、35.3%分别提高到2000年后的98.8%、95.6%;移植肾的半数生存期由13.1年提高到21.7年。多因素分析显示移植年代、原发肾脏疾病、ABO血型配对、移植肾功能延迟恢复、急性排斥反应以及免疫抑制治疗方案是影响移植肾存活的独立危险因素;感染、心脑血管疾病和肝功能衰竭是移植受者死亡的主要原因。结论肾移植是成功救治晚期肾脏疾病患者的有效方法,移植肾的长期存活受诸多因素影响,感染、心脑血管疾病和肝功能衰竭是严重威胁患者存活的并发症。
Objective To review the clinical data of renal transplantation in the Chinese People’s Liberation Army General Hospital in the past 28 years and analyze the risk factors that affect the survival of renal allografts and the causes of their death. Methods From October 1977 to December 2004, a total of 2037 kidney transplants were performed in 1804 patients with end-stage renal disease. According to the clinical data and the follow-up results as of the end of 2005, the Kaplan-Meier method was used to calculate the survival rate of human and renal allografts. The half survival and standard errors of the grafted kidney were calculated according to Terasaki’s formula. The causes of death were analyzed by univariate and multivariate (Cox model) analyzes, and the statistical significance was determined by log-rank test and t-test. Results The overall graft survival rates at 1, 5, 10, 15 and 20 years were 91.4%, 79.0%, 63.9%, 53.3% and 47.6%, respectively. The number of transplants in one year after transplantation increased significantly from 40.0% and 35.3% in the 1970s to 98.8% and 95.6% after 2000 respectively. The median survival time of the transplanted kidneys increased from 13.1 years Increased to 21.7 years. Multivariate analysis revealed that primary kidney disease, ABO blood group pairing, delayed graft recovery, acute rejection, and immunosuppressive regimens were independent risk factors for graft survival at transplantation age; infections, cardiovascular and cerebrovascular diseases, and liver failure Is the main cause of death in transplant recipients. Conclusion Renal transplantation is an effective method for successful treatment of patients with advanced renal disease. The long-term survival of renal transplant recipients is affected by many factors. Infection, cardiovascular and cerebrovascular diseases, and liver failure are serious complications that threaten the survival of patients.