Læknablaðið - 15.09.2000, Síða 31

FRÆÐIGREINAR /LIFFÆRAFLUTNINGAR
meðferð við lokastigsnýrnabilun hér á landi og af
þeim fengu 96 (46%) ígrætt nýra (9). Fjöldi
nýraígræðslna fór vaxandi með hverjum áratugi, úr
13 á þeim fyrsta í 50 á síðasta áratugi. Jafnframt
fjölgaði ígræðslum nýrna úr lifandi gjöfum og voru
þeir um 65% græðlinga á síðasta áratugi. I lok 1997
voru starfandi nýragræðlingar 59 og af þeim voru 45
úr lifandi gjöfum. Sjúklingar með ígrædd nýru voru
þá 70% allra í meðferð vegna lokastigsnýrnabilunar.
Meðalaldur sjúklinga við ígræðslu var 36 ár en aðeins
þrír voru yfir 60 ára aldri og var sá elsti 61 árs.
Eins og sést á mynd 1 eru gauklabólga og langvinn
millivefsnýrabólga algengustu orsakir
lokastigsnýrnabilunar hérlendis, en vakið hefur
athygli að hér á landi er sykursýkinýrnamein
tiltölulega sjaldgæf orsök nýrnabilunar á lokastigi.
Á áðurnefndu tímabili hefur eins árs lifun
græðlinga úr lifandi gjöfum verið 96% og fimm ára
lifun 89% sem telst góður árangur. Lifun græðlinga
úr látnum gjöfum reyndist fremur slök en eins árs
lifun var aðeins 61% og fimm ára lifun 48%. Engin
skýring liggur fyrir á þessari slöku lifun græðlinga frá
látnum gjöfum en rannsóknir standa nú yfir sem
beinast að því að finna orsök þess.
Niðurlag
Miklar framfarir hafa átt sér stað síðan fyrsta
nýraígræðslan var gerð fyrir rúmum 40 árum. í dag er
nýraígræðsla kjörmeðferð sjúklinga með nýrnabilun
á lokastigi. Skortur á nýrum til ígræðslu og tap
græðlinga vegna langvinnrar höfnunar eru þó enn
veruleg vandamál sem hafa leitt til myndunar langra
biðlista eftir nýrum til ígræðslu. Rannsóknir miða nú
að því að bæta langtímaárangur nýraígræðslu meðal
annars með þróun sértækari ónæmisbælandi lyfja.
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