肾移植受者死亡原因分析

目的 分析肾移植受者死亡原因,为提高肾移植受者长期生存率提供参考.方法 回顾性分析1990年1月至2010年12月间进行的2656例同种异体肾移植手术,共死亡285例,按肾移植时的年份分为1990~1995年(A)、1996~2000年(B)、2001~2005(C)、2006~2010年(D)4组,分析比较各组死亡率变化趋势.统计不同时间段死亡例数及各死亡原因构成比,并将其分为移植肾失功能死亡组(n=181)和移植肾带功能死亡组(n=104),对两组死亡原因进行比较分析.结果 4组肾移植受者死亡率分别为:A组28.21%;B组15.57%;C组8.14%、D组3.41%,B、C、D组与A组比较,差异有统计学意义(P<0.001).27.72%(79例)患者于肾移植术后3个月内死亡,该期死亡的主要原因是慢性充血性心力衰竭、感染;15.79%(45例)患者于术后3～5年死亡,死亡的原因主要为感染、慢性充血性心力衰竭.前3位死亡原因分别是,失功能组:慢性充血性心力衰竭(74例,40.88%)、肺部感染(26例,14.36%)、药物性肝衰竭(18例,9.94%);带功能组:肺部感染(46例,44.23%)、药物性肝衰竭(21例,20.19%)、心血管意外(2例,占1.92%).结论 肾移植受者死亡率随时间的发展呈明显下降趋势,患者死亡有两个高峰期:第一个是术后3个月,第二个是术后3～5年,感染是移植肾带功能组死亡的最主要原因,因心血管疾病死亡的风险在移植肾失功的受者中显著增加,加强对肺部感染及慢性充血性心力衰竭等并发症的防治十分关键.

Analysis of the death causes of renal transplantation recipients

Objective To analysis the causes of death in recipients after kidney transplantation,so as to provide reference to the improvement of long-term survival after kidney transplantation.Methods A retrospective analysis between January 1990 and December 2010 was performed on 2656 cases of renal transplantation operation in our hospital,a total of 285 cases of death,which were divided into four groups:1990-1995(A),1996-2000(B),2001-2005(C),2006-2010(D)according to the year of renal transplantation.The paper made an analysis and comparison of the trends of mortality in each group,collecting statistics of the cases of death during different periods and the constituent ratio of the cause of death,which was divided into two groups.One was death of renal dysfunction(n=181)and the other was death of functional renal allograft(n=104).The causes of death of them were analyzed finally.Results Mortality in renal transplantation recipients were:A group(28.21%);B group(15.57%);C group(8.14%);D group(3.41%).Compared with group A,the differences(P<0.001)were significant in group B,C,D.27.72%(79 cases)of kidney transplant patients died within 3 months,due to chronic congestive heart failure and infection;15.79%(45 cases)of renal transplant recipients died within 3 to 5 years,the causes of whose death were infection and chronic congestive heart failure.The top three causes of death in renal dysfunction group were respectively chronic congestive heart failure(74 cases,40.88%),lung infection(26 cases,14.36%),drug-induced liver failure(18 cases,9.94%).As for the group of functional renal allograft,the deaths were caused by pulmonary infection(46 cases,44.23%),drug-induced liver failure(21 cases,20.19%),cardiovascular accident(2 cases,1.92%).Conclusions Mortality in renal transplant recipients was obviously decreased with development of the time.The two peak periods of the mortality after renal transplantation are 3 months later after surgery and 3 to 5 years after surgery.Infection mainly causes the death of functional renal allograft.The risk of the death caused by cardiovascular disease is increased in renal dysfunction.Therefore,it is essential for doctors to strengthen prevention and treatment of the pulmonary infection and other complications of chronic congestive heart failure.