The Analysis Of The Cause Of Death After Renal Transplantation

Kidney transplantation is regarded as the best way to cure theend stage renal disease(ESRD),With the development ofimmunosuppressant and techniques in operation, the survival rate ofpatients or allograft has been improved greatly, but there are still alot of patients died from diverse reasons after kidney transplantation,and lead to the loss of allograft. So it is important to analyze thecause of death of patients, prophylaxis the risk factors, decrease themorbidity of common complications and decease the death ofpatients.We have collected 354 patients received kidney transplantationbetween January 2002 and March 2005,and follow up one year, 27cases died, the mortality in one year is 7.69%;among them, 8 diedfrom infections, 1 died in one month after operation, and 6 caseshave normal function of allograft, simple bacterium infections2cases, simple cytomegalovirus infections 1 case, combineinfections 4 cases, and 1 case haven't detected pathogen,6 had thecase history of AR(acute rejection).7 died from cardio-cerebralvascular disease, among them 4 died from cardio-vascular disease,3died from cerebral-vascular disease,among them 4 died in onemonth after KT(kidney transplantation),and only 2 had normalallograft function.3 died from allograft rupture, all had the casehistory of AR which was proved by the pathology after allograftnephrectomy, 2 died of hepatic failure,1 infected hepatitis B and 1infected hepatitis C before operation.2died from malignantneoplasm,1 died from stress ulcer,2 gave up curing because ofeconomy,2 died from the other reasons。Among them,12 patientshad normal allograft function (44.44%)。Infections,cardio-cerebral vascular disease,allograft ruptureare the mainly cause of the death. Pneumonia is the most frequentcomplication in infections, and the pathogen spectrum includesbacterium, virus, fungus etc. and combine infections are morecommon, and the died patients having normal allograft functionoccupied large percentage, the long time dialysis, bad healthcondition, latent infection, impulse therapy of AR ,abuse ofantibiotic and so on are the high risk factors. Establish regularfollow-up, prevent cross-infection, correct use of antibiotic andadjust the doses of immunosuppressant in time is essential to reduceinfections morbidity. cerebral-vascular disease occurs in earlierperiod after kidney transplantation, because of hypertension,hyperglycaemia , hyperlipemia, a lot of patients combinedartherosclerosis, plus didn't dialyze regularly, retention of sodiumand water, acid-base imbalance, the influence ofimmunosuppressant to blood pressure, blood sugar, blood-fat , themorbidity of cerebral-vascular disease are higher, especially inpatients with delayed discovery or bad function of allograft. So itis pivotal to dialyze regularly before KT, to control the bloodpressure, blood sugar and blood-fat after KT, and to hemodialysis ifnecessary for decreased morbidity of cerebral -vascular disease .The rupture of transplanted kidney is related with acute rejection.Abundant use of anti-rejection agents can reduce mortality whenacute rejection happens. If conservative therapy is useless whenkidney is ruptured, operative exploration is also necessary toreduce mortality. Most patients complicating hepatic disease orhepatic failure after KT were those who had hepatitis B or C or both.They had history of chronic hepatic disease and destroyed function.So after KT, they should have early protective hepatic therapy andlow toxicity immunosuppressive agent. And sometime, It isnecessary to quit agent and all immune drugs, giving uptransplanted kidney. Malignant neoplasm occurred in the late stageafter KT, and increases with the time longer. Chronic virus infectionand usage of immunosuppressive agent are major factors to lead tomalignant neoplasm after KT. It is important to diagnose and dealwith in time. But the pivotal choice is to cut out the neoplasm ifnecessary. The ulcer and hemorrhage in digestive tract are relatedwith history of digestive disease and abundant hormones aftertransplantation. So we should exact patients carefully ,cure ulcerand use anti-acid agent preventively before operation, whichreducing the morbidity of those diseases.It is essential to strengthen the diagnosis and treat early andprovide effective treatment immediately in patients with renaltransplantation, and to take preventive measures to decrease themortality of KT.