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目的探讨肾移植术后早期排斥反应所致移植肾功能延迟恢复(DGF)的诊断、治疗方案及效果,对远期人/肾存活的影响。方法回顾分析1999年4月~2003年4月肾移植术后早期排斥反应所致DGF患者的临床资料,共35例。结果24例术后无尿,11例术后2~5d出现少尿、无尿。经临床、彩超、移植肾穿刺活检诊断为排斥反应。所有患者接受ATG加FK506加MMF加Pred免疫抑制方案,定期透析。治疗后平均来尿时间为25d(10~98d),6个月内32例肾功能恢复正常,3年人存活率97.14%(34/35),移植肾存活率94.29%(33/35)。32例有功能肾患者的平均尿量为(1 986.4±869.7)ml/d,血肌酐(101.5±57.3)μmol/L,尿素氮(7.9±2.76)mmol/L。结论早期排斥反应所致DGF应尽早采用ATG加FK506加MMF加Pred免疫抑制方案,绝大多数都能恢复,远期人/肾存活良好。
Objective To investigate the diagnosis, treatment and effect of delayed graft rejection (DGF) induced by early rejection after renal transplantation and its effect on long-term human / kidney survival. Methods The clinical data of 35 patients with DGF induced by early rejection after renal transplantation from April 1999 to April 2003 were retrospectively analyzed. Results 24 cases of postoperative anuria, 11 cases of 2 ~ 5d after the emergence of oliguria, anuria. After clinical, ultrasound, renal biopsy diagnosis of rejection. All patients received ATG plus FK506 plus MMF plus Pred immunosuppressive regimen, regular dialysis. The average urinary time was 25d (10 ~ 98d) after treatment. 32 patients recovered to normal within 3 months, the survival rate of 3 years was 97.14% (34/35), and the survival rate of graft was 94.29% (33/35). The average urine volume of 32 patients with functional renal disease was (986.4 ± 869.7) ml / d, serum creatinine (101.5 ± 57.3) μmol / L, urea nitrogen (7.9 ± 2.76) mmol / L. Conclusion Early rejection induced by DGF should adopt ATG plus FK506 plus MMF plus Pred immunosuppression as soon as possible. Most of them can recover, and long-term human / kidney survival is good.