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肾移植后患者生存状况

Author
John Vella, MD, FACP, FRCP, FASN
Section Editor
Daniel C Brennan, MD, FACP
Deputy Editor
Albert Q Lam, MD
Translators
陈继红, 主任医师

引言

肾移植是特定终末期肾病(end-stage renal disease, ESRD)患者的首选治疗[1]。与维持性透析相比，成功肾移植可改善大多数患者的生存质量且降低死亡风险[2-4]。对于接受血液透析和腹膜透析治疗的患者而言，二者在肾移植术后的死亡率和整体肾移植的失败率均无显著差异[5]。

以下内容将总结肾移植受者生存情况的相关数据。移植肾短期和长期存活的决定因素将单独讨论。 (参见“肾移植中移植物失功的危险因素”)

概述

过去10年间，肾移植后移植肾存活率和患者生存率有所改善。过去10年间，成人受者和儿科受者中死亡删失的移植肾存活率均稳步增加[6]。移植受者科学注册系统(Scientific Registry of Transplant Recipients, SRTR)提供的数据显示，对于活体和死亡供者，移植肾的10年总体存活率都已从10年前的35%-40%上升为目前的55%-60%。特别是死亡删失的移植肾存活率得到改善，而在这10年间受者死亡时移植肾仍有功能的情况增加，从而削弱了总体移植肾存活率的改善。这可能反映出前者中有更好的免疫抑制，而后者为一个有更多共存疾病的较年长患者人群。

活体供者肾移植相较于死亡供者肾移植的长期优势，在那些预期寿命较长且共存疾病较少的患者中体现得最明显，如儿科患者人群。

过去10年间，在接受肾移植的成人患者中，肾移植后90日内早期移植肾失功率以及肾移植后1年时估计肾小球滤过率(glomerular filtration rate, GFR)均有改善。加拿大一项回顾性研究证实了肾移植的优势，该研究将肾移植的结局(肾源包含所有供者类型；202例符合扩展标准，642例符合常规标准，673例为活体供肾移植)与173例参与强化家庭血液透析项目治疗的患者的结局(每周接受16个小时的血液透析治疗)进行了比较，结果发现尽管接受肾移植的患者队列在移植后的头3个月内有更高的住院率，但其死亡和治疗失败(定义为永久转为替代透析方式或移植肾失功)风险降低了50%以上[7]。

               

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Literature review current through: 2017-06 . | This topic last updated: 2016-01-13.
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