肾移植中应用抗胸腺淋巴细胞球蛋白诱导治疗的15年临床经验总结
15-year clinical experience in ATG induction after renal transplantation
目的 总结应用抗胸腺淋巴细胞球蛋白(ATG)诱导联合标准免疫抑制方案治疗的经验,提高肾移植后人、肾长期存活率.方法 回顾性分析1997年1月至2012年1月间1632例次应用ATG诱导联合标准免疫抑制方案的肾移植受者的临床资料.统计术后1、3、5、10、15年人、肾存活率,移植后并发症及其处理原则,及其他影响移植效果的因素.结果 肾移植后1、3、5、10、15年的人、肾存活率分别为97.0%和96.7%、93.2%和87.8%、88.2%和77.8%、78.5%和51.7%、40.2%和30.4%.术后急性排斥反应(AR)发生率为9.1%(149例次),移植肾功能恢复延迟发生率7.7% (126例次),慢性移植肾功能丧失发生率为17.9%(292例次).移植后感染发生率为13.4%(219例次),恶性肿瘤发生率为1.2%(19例).死亡124例,死亡率为7.6%,其中死因为感染占53.2%(66例),心脑血管并发症占33.9%(42例),恶性肿瘤占8.9%(11例).结论 应用ATG诱导治疗联合标准三联免疫抑制方案可有效预防肾移植术后早期AR,是提高人、肾长期存活率的有效方法.
更多Objective To summarize the experience of ATG induction combined with standard irnmunosuppression in order to prolong the long-term survival of patient/kidney after renal transplantation.Method The data of renal transplantation in 1632 cases who received renal transplantation from Jan.1997 to Jan.2012 were summarized.The data of the recipients were calculated,such as the 1-,3-,5-,10-and 15-year survival rate of patient/graft,and other factors affecting transplantation outcomes.Results The 1-,3-,5-,10-and 15-year survival rate of patient/graft (%) was 97.0/96.7,93.2/87.8,88.2/77.8,78.5/51.7,and 40.2/30.4 respectively.The incidence of acute rejection (AR) was 9.1% (149 cases).The incidence of delayed graft function (DGF) was 7.7% (126 cases).The incidence of chronic graft dysfunction was 17.9% (292 cases).The incidence of infection and cancer after transplantation was 13.4% (219 cases) and 1.2% (19cases) respectively.Mortality of recipients after transplantation was 7.6% (124 cases).Among the 173 dead cases,53.2% (66 cases) was caused by infections,33.9% (42 cases) by cardiovascular complication,and 8.9% (11 cases) by cancer,respectively.Conclusion The regimen of ATG induction therapy combined with standard triple immunosuppressive therapy can prevent acute rejection effectively in the early period after renal transplantation.It is an effective treatment to improve long-term patient/graft survival.
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