移植肾失功后移植肾切除的作用目前尚不明确。我们在此报道1995年至2003年美国19107名移植肾失功的患者行移植肾切除的情况及其后来的结果。在3707名早期移植肾失功的患者中（移植物存活率<12个月），有56％的患者接受了移植肾切除，其与死亡的风险上升有关（HR 1.13, 95% CI 1.01-1.26）。相比而言，在15400名远期移植肾失功的患者（移植物存活率>/=12个月）中，仅27％的患者行移植肾切除，相关的死亡风险下降（HR 0.89, 95% CI 0.83-0.95）。在早期移植肾失功的患者中，移植肾切除能够降低再次移植后移植肾失功的风险（HR 0.72, 95% CI 0.56-0.94），而在晚期移植肾失功的患者中，移植肾切除能够降低升高移植后移植肾失功的风险（HR 1.20, 95% CI 1.02-1.41）。该观察性研究无法得出确切的结论。因此，对于已经行透析治疗的移植肾失功的患者行移植肾切除，其对于再次移植的影响需要进一步前瞻性研究证实。

The role of transplant nephrectomy after transplant failure is uncertain. We report the use and consequences of transplant nephrectomy among 19 107 transplant failure patients between 1995 and 2003 in the United States. Among 3707 patients with early transplant failure (graft survival <12 m), nephrectomy was performed in 56%, and was associated with an increased risk of death (HR 1.13, 95% CI 1.01-1.26). In contrast, among 15 400 patients with late transplant failure (graft survival >/=12 m), nephrectomy was performed in 27%, and was associated with a decreased risk of death (HR 0.89, 95% CI 0.83-0.95). In early transplant failure patients, nephrectomy was associated with a lower risk of repeat transplant failure (HR 0.72, 95% CI 0.56-0.94), while among late transplant failure patients，nephrectomy was associated with a higher risk of repeat transplant failure (HR 1.20, 95% CI 1.02-1.41). Definitive conclusions are not possible from this observational study. The role of nephrectomy in the management of dialysis treated transplant failure patients, and the implications of nephrectomy for repeat transplantation should be further studied in prospective studies.

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