供体特异性输血在亲体肾移植的初步分析

Donor-specific blood transfusion in living related renal transplantation

目的探讨供体特异性输血对亲体肾移植患者围手术期并发症和术后人肾存活率的影响。方法将我院2005—2007年收治的52例亲体肾移植患者按是否进行供体特异性输血分为供体输血组和对照组，供体输血组于术前3d采集全血200—400ml，术中用于受者；对照组术中随机使用库存血。对比分析两实验组在肾移植后移植肾的功能（血肌酐测定）、急性排斥反应发生率、移植肾功能延迟恢复（delayedgraftfunction，DGF）发生率。结果供体输血组和对照组在供肾GFR、HLA配型、供者和受者年龄方面无显著差异（P〉0．05）。供体输血组术中输供体全血（334±56．4）ml，随机输注浓缩红细胞（238±105）ml；对照组输注浓缩红细胞（698±243）ml。供体输血组与对照组术后1周血肌酐水平无显著差异（P〉0．05），术后急性排斥反应和DGF发生率低于对照组（分别为3．57％、16．67％）。结论供体特异性输血可明显减少移植术中库存非亲体血使用量，减少术后急性排斥和DGF发生率，有效提高了移植受者围手术期的成功率。

Objective To observe the impact of donor-specific blood transfusion on the recovery during perioperative period in living related kidney transplantation. Methods Fifty-two patients underwent living related renal transplantation during 2005 -2007, of whom 28 patients received donor-specific blood transfusion （DST） and 24 patients received random transfusion as controls. The whole blood of 200 -400 ml was harvested from the donor 3 days before the operation and infused into the recipient assigned to DST during the operation, while the controls were transfused with nonspecific donor blood. Serum creatinine, acute rejection rate, delayed graft function rate were compared. Results No significant difference existed in donor kidney glomerular filtra- tion rate, HLA matching, age of donors or recipients. DST patients consumed the whole blood of （334 ± 56.4） ml and concentrated red blood cells of （238 ± 105） ml, while the control patients only used the concentrated red blood cells of （698±243） ml. Serum creatinine showed no significant difference a week after operation in the DST patients and control patients. The incidence of acute rejection and delayed graft function in DST patients was lower than that in control patients （1/28 vs 4/24）. Conclusion Donor-specific blood transfusion consumes less banked blood in renal transplantation and decreases the incidence of acute rejection and delayed graft function.