探究再次肾移植受者和移植肾存活情况及长期预后影响因素。

回顾性分析1991年1月1日至2017年12月31日于浙江大学医学院附属第一医院肾脏病中心接受肾移植受者临床资料。共纳入再次肾移植受者37例，首次肾移植受者5 374例。根据再次肾移植受者移植肾存活时间长短，将其分为长期存活组(19例，>5年)和短期存活组(18例，≤5年)。采用成组t检验比较长期和短期存活组供受者年龄、首次与再次肾移植间隔时间、HLA错配数和再次移植供肾冷/热缺血时间。采用卡方检验比较长期和短期存活组受者性别、再次移植供肾类型、再次移植前后群体反应性抗体阳性比例、首次移植失功移植肾切除比例、再次移植前免疫诱导比例及再次移植后移植肾功能延迟恢复(DGF)和急性排斥反应发生比例。采用Kaplan-Meier法分析再次和首次肾移植受者/移植肾1、5和10年存活率。采用Cox比例风险模型分析影响再次肾移植术后移植肾长期存活影响因素。P<0.05为差异有统计学意义。

截至2018年3月1日，37例再次肾移植受者中位随访时间为152个月(11～323个月)，2例死亡，18例发生移植肾失功，17例移植肾功能稳定。5 374例首次肾移植受者中位随访时间为108.9个月(0.1～350.0个月)，459例死亡，1 343例发生移植肾失功。再次移植组受者/移植肾1、5和10年存活率分别为86%/81%、86%/62%和82%/36%，首次移植组受者/移植肾1、5和10年存活率分别为99%/98%、93%/89%和88%/80%。再次移植组移植肾1、5和10年存活率均低于首次移植组(χ²＝60.816、25.110和43.900，P均<0.05)；再次移植组受者1年存活率低于首次移植组，差异有统计学意义(χ²＝40.409，P<0.05)。长期和短期存活组受者再次移植后移植肾DGF和急性排斥反应发生比例差异均有统计学意义(χ²＝4.039和4.748，P均<0.05)。Cox回归分析结果示DGF和急性排斥反应是影响再次肾移植受者移植肾长期存活的独立危险因素，差异有统计学意义(RR＝4.317和4.571，P均<0.05)。

再次肾移植受者移植肾存活率低于首次肾移植受者，DGF和急性排斥反应是影响再次移植受者移植肾存活的独立危险因素。

To investigate the risk factors of kidney re-transplantation recipients and graft survival during the long-term follow-up.

The clinical data of kidney transplant donors and recipients performed at the Kidney Disease Center of the First Affiliated Hospital of Zhejiang University from January 1, 1991 to December 31, 2017 were retrospectively analyzed. A total of 5 374 cases of first kidney transplantation and 37 cases of re-transplantation were included. In addition, the recipients of re-transplantation were divided into long-term survival group (19 cases, >5 years) and short-term survival group (18 cases, ≤5 years). The age of donor and recipient, the interval between first and second kidney transplantation, HLA mismatch and cold/warm ischemia time of donor and recipient in long-term and short-term survival groups were compared by group t test. Chi-square test was used to compare the gender of recipients, type of donor kidney, rate of positive panel reactive antibodies before and after re-transplantation, initial graft nephrectomy, immune induction before re-transplantation, delayed graft function (DGF) and acute rejection in two groups. The 1, 5 and 10-year patient/graft survival rates were calculated by Kaplan-Meier method. The Cox proportional hazard model was used to analyze the possible risk factors on long-term survival of transplanted kidney. P<0.05 was statistically significant.

As of March 1, 2018, the median follow-up time of re-transplantation group was 152 months (11-323 months), 2 recipients died, 18 reipients suffered from renal allograft dysfunction and 17 patients had stable renal transplant function. The median follow-up time of the first transplantation group was 108.9 months (0.1-350.0 months). 459 cases died and 1 343 cases suffered from renal transplant failure. The 1, 5 and 10-year recipient/graft survival rates in the re-transplantation group were 86%/81%, 86%/62% and 82%/36%, and the 1, 5 and 10-year recipient/graft survival rates in the first transplantation group were 99%/98%, 93%/89% and 88%/80%. The 1, 5 and 10-year recipients survival rates of re-transplantation group were lower than those in the first transplantation group (χ²= 60.816, 25.110 and 43.900, P<0.05), and the 1-year recipients survival rate in the re-transplantation group was lower than the first transplantation group (χ²= 40.409, P<0.05). Univariate analysis showed that there were significant differences in DGF and acute rejection rates between long-term and short-term survival groups (χ²=4.039 and 4.748, P<0.05). Cox regression analysis showed that DGF and acute rejection were independent risk factors for long-term survival of transplanted kidneys in re-transplanted recipients (RR=4.317 and 4.571, P<0.05).

The survival rate of re-transplant recipients is lower than that of the first renal transplant recipients. DGF and acute rejection are independent risk factors affecting the survival of re-transplant recipients.