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目的 分析影响肾移植存活的因素 ,以提高肾移植术后长期存活率。 方法 采用SAS软件 ,统计 2 0 16例 (2 10 5次 )肾移植受者群体中的 33个相关变量。用Kaplan Meier曲线计算 1、3、5、10年移植肾存活率及移植肾半生存期 ,用Log rank方法进行单变量分析 ,采用COX模型多元回归计算相对危险度。 结果 移植肾 1、3、5、10年存活率分别为 83% (15 4 3/185 9)、75 % (112 5 /15 0 0 )、6 6 % (80 0 /12 12 )、4 8% (2 91/6 0 7) ,剔除有移植肾功能死亡的病例后 ,存活率则为 89% (16 5 5 /185 9)、82 % (12 30 /15 0 0 )、75 % (90 9/12 12 )、6 9% (419/6 0 7) ,两者的移植肾半生存期分别为 (8 78± 0 14 )年和 (14 0 9± 0 2 0 )年。与肾移植长期存活关系密切的单变量有 :供肾缺血时间 ,移植次数 ,免疫抑制药 (ISA)种类和组合 ,排斥 ,移植肾功能恢复正常时间及术后肌酐水平 ,急性肾小管坏死 (ATN) ,移植肾功能延迟恢复 (DGF) ,急性排斥的治疗方法 ,感染并发症等因素。 结论 免疫抑制剂的改进提高了肾移植短期存活率 ,也显示出长期存活的趋势。提高供肾质量 ,降低带有移植肾功能的患者的死亡率是现阶段提高移植肾长期存活率的一个最有可能实现的途径。
Objective To analyze the factors influencing the survival of renal allografts in order to improve the long-term survival rate after kidney transplantation. Methods SAS software was used to analyze 33 related variables in 2016 (2 105) renal transplant recipients. Kaplan-Meier curves were used to calculate the 1,3,5 and 10-year graft survival and half-life of the graft. Univariate analysis was performed using the Log rank method. Multiple regression was used to calculate the relative risk. Results The survival rates at 1, 3, 5 and 10 years were 83% (15 4 3/185 9), 75% (112 5/1500), 6 6% (80 0/12 12), 48 % (91/60). After excluding the cases of renal allograft death, the survival rates were 89% (16 5 5/195 9), 82% (12 30/1500), 75% (90% 9/12 12) and 69% (419/6 0 7) respectively. The median survival time of the two groups was (8 78 ± 0 14) years and (14 0 9 ± 0 0 0) years respectively. The univariable variables closely related to the long-term survival of renal allografts included kidney ischemia time, number of transplantation, types and combinations of immunosuppressive drugs (ISA), rejection, normal time of renal function recovery, postoperative creatinine level, acute tubular necrosis ATN), delayed graft function (DGF), treatment of acute rejection, complications of infection and other factors. Conclusion The improvement of immunosuppressive agents improves the short-term renal transplant survival rate, but also shows long-term survival trend. Increasing renal mass and reducing mortality in patients with grafted kidney function is one of the most promising ways to increase long-term graft survival at this stage.