亲属活体供肾移植14例分析

Clinical analysis of 14 cases of living-related-donor kidney transplantation

目的总结14例亲属肾移植的经验,探讨活体供肾的临床效果。方法13例为血缘亲属供肾,1例为非血缘亲属供肾,血型相同,淋巴毒试验阴性,4例HLA配型中,全配1例,单配体相同3例。4例取供者右肾,10例取供者左肾,13例经开放手术取肾,1例经腹腔镜取肾。术后采用环孢素、霉酚酸酯或硫唑嘌呤及泼尼松预防排斥反应。结果供者术后1周出院,随访1个月-1年肾功能正常。受者14例中13例至今存活,肾功能良好,1例肾失功。术后发生急性排斥反应1例,经抗淋巴细胞球蛋白冲击治疗逆转。2例发生肾功延迟恢复,分别于1周及3周肾功能恢复正常,其余12例术后3天肾功能正常,无外科并发症。结论亲属活体供肾移植组织配型好,缺血时间短,排斥反应发生率低,免疫抑制剂用量少。

Objective To summarize the experience in performing living related kidney transplantation in 14 cases and evaluate the clinical results. Methods Thirteen cases were blood relationship donors and one was spouse donor with the same blood type and negative reaction to lymphotoxicity test. Four cases underwent HLA matching, with three sharing one haplotype and one sharing two haplotypes. One graft kidney was taken by laparoscopic nephrectomy, the others via open surgery. Triple - combined immunosuppressive protocols consisting of cyclosporine, mycophenolate mofetil and steroid, were used to prevent graft rejection. Results All donors were discharged one week after the operation, with the kidney function normal during the period of follow - up for one month to one year. Thirteen of the recipients were still alive with normal functioning grafts, while one was lost from the follow - up. Acute rejection （AR） episode occurred in 1 recipient, which was reversed by intravenous administration of antilymphoglobulin. Delayed graft function （DGF） occurred in two recipients; renal function became normal in the other 12 recipients within 3 days after operation. Conclusions Optimal HLA matching and shorter ischemia time benefit low incidence of DGF and AR, less need of immunosuppressants and rapid recovery.