尸肾移植后肾功能延迟恢复的原因及防治

Reasons and treatment of delayed sraftfunction of cadaveric renal transplantation

肾移植术后功能延迟恢复（ＤＧＦ）的因素甚多，国外报道其发生率高达１０％～６０％。本文介绍我院１５年来的尸体肾移植情况：ＤＧＦ发生率仅为５．７４／．远低于国外报道。其原因分别为急性肾小管坏死（ＡＴＮ），占７７．５９％；急性排异反应，占１５．５２％；泌尿系并发症，占５．１７％；急性ＣｓＡ肾毒性，占１．７２％。其预防方法包括：选择年轻健康供者；缩短热、温缺血时间；保存液中引进钙离子拮抗剂；木中避免缩血管药物的应用及避免术后泌尿系并发症的发生；经济条件允许者预防性应用单、多克隆抗体；警惕急性ＣｓＡ肾毒性。

ackground and objective There are manyfactors leading to delayed graft function(DGF) of cavaderic renal transplantation,the incidence of which had been reported tobe as high as 10%～60% abroad. The aimof the present work was to analyze the rea-sons and management of this problem.Methods and results Retrospective studyon the clinical data of the 969 cases of renaltransplantation during the past 15 years inour hospital. Results showed that DGF oc-curred in 58 patients (5. 74%) ,and the di-agnosis of DGF was made according to clini-cal manifestatoins , biochemistry , ultrsonog-raphy and fine needle biopsy of the graftkidney.Conclusions We believe that the followingmeasures are essential for the prevention ofDGF : choosing young healthy donor ; short-ening heat/warm ischemia time iadding cal-cium antagonist to the preservation solu-tion;avoiding the use of vasoconstrictive a-gents during and postoperation ;avoiding theoccurrence of postoperative urological com-plications ;prophylectic application of tnono-or polyclone antibodies if possible;and cau-sious of CsA nephrotoxicity.