分析肾移植术后发生移植肾功能不全的影响因素，为实现移植肾长期存活提供经验。

回顾性分析2013年1月至2015年12月在四川大学华西医院接受肾移植手术的592例受者临床资料，包括：供者性别、血清肌酐水平以及估算肾小球滤过率(eGFR)；受者年龄、性别、民族、体质指数(BMI)、HBsAg、血清肌酐水平以及他克莫司个体内变异(Tac-IPV)；供肾类型、HLA错配数。根据移植肾存活情况将受者分为移植肾功能不全组和移植肾功能稳定组。根据Tac-IPV中位数将受者分成高变异组(Tac-IPV≥32.1)和低变异组(Tac-IPV<32.1)。根据《中国成人超重和肥胖症预防控制指南》标准，将受者分为低BMI组(<18.5 kg/m²)、正常BMI组(18.5～<24 kg/m²)和高BMI组(≥24 kg/m²)。采用t检验或U检验比较供者捐献前血清肌酐水平和eGFR以及受者年龄、BMI、血清肌酐水平和Tac-IPV。将单因素分析中P<0.10的变量纳入Logistic回归多因素分析。采用Kaplan-Meier法绘制移植肾生存曲线并使用log-rank检验进行比较。采用Cox比例风险模型分析影响移植肾生存的危险因素。采用卡方检验比较供者性别以及受者性别、民族、HBsAg、供肾类型和HLA错配数。P<0.05为差异有统计学意义。

592例肾移植受者平均年龄(33±9)岁(18～60岁)，男性452例，女性140例；汉族519例，少数民族73例。移植肾功能稳定组和功能不全组分别纳入533例和59例受者。随访至2017年8月，592例受者平均随访时间为(30±11)个月(1～54个月)。移植肾功能稳定组受者性别、民族、BMI和Tac-IPV与移植肾功能不全组差异均有统计学意义(χ²/U＝5.040、3.677、6.710和30.152，P均<0.05)。Logistic回归多因素分析结果提示，受者性别、民族、BMI和Tac-IPV是移植肾功能不全的独立危险因素(OR＝0.308、1.101、2.246和137.369，P均<0.05)。女性受者移植肾存活率高于男性受者，Tac-IPV高变异组移植肾存活率低于低变异组，差异均有统计学意义(χ²＝5.88和27.04，P均<0.05)。高BMI组受者移植肾存活率最低，低BMI组移植肾存活率低于正常BMI组，差异有统计学意义(χ²＝8.071，P<0.05)。Cox比例风险模型分析结果显示，影响移植肾生存的危险因素分别为受者性别、民族、BMI和Tac-IPV(HR＝2.934、0.506、51.291和1.077，P均<0.05)。

早期发现并干预肾移植受者BMI和Tac-IPV，有助于维持移植肾长期存活，改善受者预后。

Factors of renal insufficiency after renal transplantation were analyzed to provide a better methods for the long-term survival of the graft.

Clinical data of 592 renal transplantation recipients in West China Hospital of Sichuan University from January 2013 to December 2015 were retrospectively analyzed, including gender of the donor, serum creatinine level and estimated glomerular filtration rate(eGFR); recipients age, gender, ethnicity, body mass index (BMI), HBsAg, serum creatinine level and Tacrolimus-intra patient variant (Tac-IPV); donor kidney type, HLA mismatch number. According to the survival of renal allografts, the recipients were divided into renal insufficiency group and stable renal allograft group. The recipients were divided into high variation group (Tac-IPV≥32.1) and low variation group (Tac-IPV<32.1) on the basis of the median of Tac-IPV. According to the Chinese Adult Overweight and Obesity Prevention and Control Guidelines, the recipients were divided into low BMI group (<18.5 kg/m²), normal BMI group (18.5-<24 kg/m²) and high BMI group (≥24 kg/m²). The t-test or U test was used to compare the donor′s pre-donation serum creatinine level, eGFR and the recipient′s age, BMI, serum creatinine level and Tac-IPV. Variables with P<0.10 in univariate analysis were included in multivariate Logistic regression analysis. Kidney allograft survival curves were plotted using the Kaplan-Meier method and compared using the Logrank test. Cox proportional hazards model was used to analyze the risk factors affecting renal allograft survival. Chi-square test was used to compare the donor′s gender and the recipient′s gender, ethnicity, HBsAg, donor kidney type, and number of HLA mismatches. P<0.05 was considered statistically significant.

The average age of 592 renal transplantation recipients was (33±9) years (18-60 years), including 452 males and 140 females. There were 519 cases of Han nationality and 73 cases of ethnic minorities. 533 patients in the stable group and 59 patients in the insufficiency group were included, respectively. As of August 2017, the average follow-up time of the recipients was (30±11) months (1-54 months). The difference of gender, ethnicity, BMI and TC-IPV of recipients between the renal insufficiency group and stable renal allograft group were statistically significant (χ²/U=5.040, 3.677, 6.710 and 30.152, P all<0.05). Logistic regression multivariate analysis showed that gender, ethnicity, BMI and Tac-IPV of recipients were independent risk factors for renal graft dysfunction (OR=0.308, 1.101, 2.246 and 137.369, P all<0.05). The survival rate of transplanted kidney in female recipients was higher than that in male recipients, and the survival rate of transplanted kidney in the high-variation Tac-IPV group was lower than that in the low-variation Tac-IPV group, the differences were statistically significant (χ²=5.88 and 27.04, P all<0.05). The survival rate of transplanted kidney in the high BMI group was the lowest, and the survival rate of transplanted kidney in the low BMI group was lower than that in the normal group, the difference was statistically significant (χ²=8.071, P<0.05). Cox proportional risk model analysis showed that the risk factors affecting the survival of kidney transplantation were recipients gender, ethnicity, BMI and Tac-IPV (HR=2.934, 0.506, 51.291 and 1.077, P all<0.05).

Early detection and intervention of BMI and Tac-IPV can help to maintain the long-term survival of renal allografts and improve the prognosis of recipients.