多次心肺复苏体外膜肺氧合支持后器官捐献供肾移植的临床疗效分析

Clinical outcomes of DCD renal transplantation after extracorporeal membrane oxygenation support with multiple cardiopulmonary resuscitation

目的比较多次心肺复苏后公民逝世后器官捐献（donationaftercitizen’sdeath，DCD）供肾移植与无心肺复苏史DCD供肾移植的临床疗效。方法回顾性分析了2012年7月至2014年12月完成的250例DCD供肾移植供、受者的临床资料。根据器官获取前是否发生多次心肺复苏（2次或2次以上）将其分为多次心肺复苏后D（如供肾移植组（观察组，17例）和无心肺复苏史供肾移植组（对照组，233例），多次心肺复苏供者均使用体外膜肺氧合（ECMO）技术支持。比较两组供者和受者的一般情况、受者术前血肌酐、术后不同时间点血肌酐水平、各种并发症的发生率及移植肾和受者的1年存活率。结果两组供者及受者一般情况、受者不同时间点血肌酐水平、住院时间相比较，差异均无统计学意义（P〉0．05）。观察组移植肾功能恢复延迟（13GF）发生率为17．6％（3／17），对照组DGF发生率为23．2％（54／233），差异无统计学意义（P〉0．05）。观察组术后急性排斥反应和肺部感染发生率均为11．8％；对照组分别为16．3％（38／233）及20．2％（47／233），两组间的差异均无统计学意义（P〉O．05）。Kaplan-Meier生存曲线结果显示，观察组受者和移植肾1年存活率均为94．1％，而对照组分别为92．7％和91．4％，但两组比较差异无统计学意义（P〉0．05）。结论多次心肺复苏ECMO支持后DCD供肾移植近期临床效果与与无心肺复苏史DCD供肾移植相当。

Objective To compare the clinical outcomes of DCD renal transplantation from donors after extracorporeal membrane oxygenation （ECMO） support with multiple cardiopulmonary resuscitation （CPR） with donors showing no CPR history prior to organ procurement. Method A retrospective study was done on 17 cases of DCD renal transplantation from donors after （ECMO） support with multiple CPR （observation group） and 233 cases of DCD renal transplantation with no history of CPR （control group） from July 2012 to December 2014. Demographic and clinical characteristics of donors and recipients, preoperative serum creatinine of recipients, postoperative serum creatinine of recipients at different time points, surgical complication, survival of graft and recipient were analyzed. Result The demographic and clinical characteristics of recipients and donors, postoperative serum creatinine of recipients at different time points and hospital stay showed no significant difference between the two groups （P〉0. 05）. The rate of delayed graft function （DGF） was 17. 6% （3/17） in the observation group and 23. 2% （54/233） in the control group respectively. There was no statistically significant difference between two groups （P〈0. 05）. The rate of acute rejection and pulmonary infection was 11.8% in the observation group, and 16. 3% （38/233） and 20. 2% （47/233） in the control group respectively. There was no significant difference between two groups （P〉0. 05）. The Kaplan-Meier results indicated that the 1-year recipient/graft survival rate was 94.1% and 94.1% in observation group, and 92.7% and 91.4% in the control group respectively. There was no significant difference between two groups （P〉0. 05）. Conclusion The clinical outcomes display no statistically significant difference between DCD renal transplantation from donors after ECMO support with multiple CPR and DCD renal transplantation from those showing no history of CPR.