华西医学

华西医学

97 例中国公民逝世后器官捐献肾移植临床研究

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目的探讨四川地区开展中国公民逝世后器官捐献(donation after citizen death,DCD)肾移植的临床效果。方法回顾性分析四川大学华西医院 2012 年 1 月—2016 年 3 月完成的 97 例 DCD 肾移植的供者及受者资料。供者 53 例,其中男 40 例,女 13 例;年龄 7 个月~54 岁(中位年龄 28 岁,下、上四分位数分别为 15、45 岁);死亡原因:颅脑外伤 21 例,颅脑肿瘤 12 例,脑血管意外 15 例,缺血缺氧性脑病 4 例,脑积水 1 例。受者 97 例,其中男 71 例,女 26 例;年龄 18~66(中位年龄 39 岁,下、上四分位数分别为 30、44 岁)。根据供者捐献类型将受者分为 C-Ⅰ类(36 例)和 C-Ⅲ类(61 例)2 组,分别分析供受者基线情况、围手术期情况,受者术后肾功能、感染发生、人肾存活等。结果无原发性肾无功能发生,26 例受者发生延迟肾功能恢复。C-Ⅰ类和 C-Ⅲ类患者术后 1 周[(226.71±187.46)、(249.94±249.84) μmol/L,P=0.636]、1 个月[(136.32±63.34)、(157.37±147.83) μmol/L,P=0.428]、3 个月[(110.51±25.26)、(115.02±36.60) μmol/L,P=0.527]及 12 个月[(103.42±21.57)、(104.18±39.36) μmol/L,P=0.911]时肌酐水平差异均无统计学意义。C-Ⅰ类和 C-Ⅲ类患者术后早期急性排斥反应发生率(13.9%、19.7%,P=0.469)及并发症等情况差异均无统计学意义。术后 1 年,C-Ⅰ类和C-Ⅲ受者人存活率(91.7%、93.4%)和移植肾存活率(100.0%、91.8%)差异均无统计学意义(P>0.05)。结论尽管 DCD 肾脏移植术后延迟肾功能恢复发生率偏高,但总体效果良好,是扩大供肾来源的有效途径。

ObjectiveTo explore the effect of donation after citizen death (DCD) kidney transplantations performed in Sichuan.MethodsThe data of 97 cases of DCD kidney transplantations performed in West China Hospital of Sichuan University between January 2012 and March 2016 was retrospectively reviewed. The 53 donors were aged from 7 months to 54 years (with a median of 28 years, and lower quartile of 15 years and upper quartile of 45 years), including 40 males and 13 females; the causes of death included craniocerebral trauma in 21 cases, craniocerebral tumor in 12 cases, cerebrovascular accident in 15 cases, hypoxic-ischemic encephalopathy in 4 cases, and hydrocephalus in 1 case. The 97 recipients were aged from 18 to 66 years (with a median of 39 years, and lower quartile of 30 years and upper quartile of 44 years), including 71 males and 26 females. The recipients were classified into C-Ⅰ (n=36) and C-Ⅲ (n=61) according to type of donation. The baseline and perioperative situation of the donors and recipients, and the postoperative kidney function, infection, recipient survival and kidney survival of the recipients were analyzed.ResultsAfter transplantation, none of primary graft nonfunction occurred but delayed graft function (DGF) occurred in 26 cases. There were no significant differences in creatinine level between C-Ⅰ and C-Ⅲ recipients at 1 week [(226.71±187.46) vs. (249.94±249.84) μmol/L, P=0.636], 1 month [(136.32±63.34) vs. (157.37±147.83) μmol/L, P=0.428], 3 months [(110.51±25.26) vs. (115.02±36.60) μmol/L, P=0.527] and 12 months [(103.42±21.57) vs. (104.18±39.36) μmol/L, P=0.911] after transplantation, as well as acute rejection [13.9% vs. 19.7%, P=0.469] and complications at early time after transplantation. There were no significant differences in 1-year recipient survival rate (91.7% vs. 93.4%) and 1-year kidney survival rate (100.0% vs. 91.8%) between C-Ⅰ and C-Ⅲ recipients.ConclusionDCD kidney transplantation has excellent short-term outcomes despite a high incidence of early DGF, and may represent another potential method to safely expand the donor pool.

关键词: 公民逝世后器官捐献; 肾脏移植; 供肾质量评估

Key words: Donation after citizen death; Kidney transplantation; Graft evaluate

引用本文: 黄中力, 蒋亚梅, 宋涂润, 王显丁, 范钰, 邱阳, 刘金鹏, 王莉, 林涛. 97 例中国公民逝世后器官捐献肾移植临床研究. 华西医学, 2018, 33(3): 307-311. doi: 10.7507/1002-0179.201711188 复制

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