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成人肾移植受者管理概述

Author
Anil Chandraker, MD, FASN, FRCP
Section Editor
Daniel C Brennan, MD, FACP
Deputy Editor
Alice M Sheridan, MD
Translators
纪志刚, 主任医师，教授

引言

肾移植是终末期肾病患者的首选治疗[1]。与维持性透析相比，成功的肾移植可以提高大多数患者的生存质量并降低死亡风险[2-4]。然而，移植后患者需要接受密切随访，因为他们使用的是复杂的免疫抑制方案，这些免疫抑制方案会使其易发感染、恶性肿瘤和心血管疾病(cardiovascular disease, CVD)。此外，患者常有多种共存疾病，这些共存疾病是其基础终末期肾病的结果或原因。

虽然患者在肾移植后的最初3-6个月一般由移植专科医生负责随访，但在这之后则可能主要由常能够处理其共存疾病的普通肾脏科医生或内科医生负责随访。患者是由移植肾脏科医生、普通肾脏科医生还是由内科医生负责随访，常取决于患者附近的医疗服务的可获得性。虽然许多人认为移植肾脏科医生应该直接参与移植物存活期间的移植受者管理，但这往往是不现实的。然而，移植中心与内科医生或社区肾脏科医生之间的交流沟通对于实现最佳的患者管理非常重要。

本专题将总结肾移植受者的一般医疗管理，包括关于监测异体移植肾功能以及最小化感染、恶性肿瘤、骨病、CVD和糖尿病的风险的推荐。移植后的常见医学问题也在此讨论。

维持性免疫抑制治疗、异体移植肾功能丧失和移植后患者生存情况将单独讨论。 (参见“成人肾移植的维持性免疫抑制治疗”和“慢性移植肾肾病”和“肾移植后患者生存状况”)

移植的特定并发症将单独讨论。 (参见“肾移植受者的泌尿道感染”和“肾移植受者中的乙型肝炎病毒感染”和“肾移植后血脂异常”和“肾移植患者中BK病毒诱导性(多瘤病毒诱导性)肾病的治疗”和“肾移植候选者和受者的丙型肝炎病毒感染”和“肾脏供者的丙型肝炎病毒感染”和“肾移植后高血压”)

                             

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Literature review current through: 2017-06 . | This topic last updated: 2016-12-16.
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