活体亲属供肾移植12例

Living related donor kidney transplantation: a clinical report of 12 cases

目的 总结活体亲属供肾移植临床经验 ,提高其治疗效果。方法 自 1972年 12月至 2 0 0 4年 5月 ,我院有 12例肾移植患者为活体亲属供肾 ,对此资料进行回顾性研究。结果 术后随访 14d～ 8 5年 (平均 4 2年 ) ,供者恢复好 ,未见并发症发生。受者 1998年前后分为A ,B两组 :A组 7例患者中 ,并发肝炎死亡 1例 ,脑疝死亡 1例 ,急排 3例 ,急性肾小管坏死 (ATN) 2例 ;B组 5例患者中 ,1例发生ATN后并发肺部感染 ;1例移植肾动脉狭窄 ,放置血管内支架扩张 ,术后肾功能恢复好 ;其余 3例无并发症 ,肾功能恢复好。结论 核磁共振血管造影术 (MRA)作为一种精确的无创性成像技术 ,用于供肾血管的术前检查效果较好。活体肾移植缺血时间短、组织配型好、免疫抑制剂用量低 ,近期效果好 ,远期效果有待进一步观察。

Objective To summarize the clinical experience of living related donor kidney transplantation(LRKT), so as to improve its therapeutic effect. Methods A retrospective analysis of 12 recipients receiving living related donor transplantation from Dec. 1972 to May. 2004 was performed. Results During a mean follow-up of 4.2 years (range from 14 days to 8.5 years), all of the 12 donors recovered smoothly and suffered no complications. The recipients were divided into two groups: group A(n=7) for transplantation before 1998, and group B(n=5) for transplantation after 1998. During the follow-up, in group A, one patient died of hepatitis, one died of cerebral hernia, three had acute rejection(AR) and two had acute tubular necrosis(ATN). In group B, one patient was complicated with ATN and had pulmonary infection subsequently. One had transplanted renal arterial stenosis(TRAS) which was corrected by stent implantion. Another three obtained fine graft function without complications. Conclusion As a non-invasive and accurate imaging examination, magnetic resonance angiography (MRA) can be utilized in the examination of donor renal vessels before transplantation. LRKT is proved to have good outcome short-term due to short ischemic time, better tissue typing and lower dose of immunosuppressive agent. Its long-term outcome needs further investigation.