亲属活体肾移植18例报告

Living relative donor kidney transplantation:A report of 18 cases

目的:总结亲属活体肾移植的临床经验,以期提高该技术的安全性及疗效。方法:选择2005-11/2006-12解放军第一七五医院收治的亲属活体肾移植患者18例,均知情同意。受体均为慢性肾小球肾炎;供体年龄24～74岁,17例有血缘关系,另一例为妻子供肾。均行经腰开放手术取肾,左侧供肾15例,右侧供肾3例。术后受体采用环孢素A+霉酚酸酯+激素三联低剂量免疫抑制剂方案。结果:①所有供体在术后10d左右出院,均无严重并发症且肾功能正常。②16例受体均在术后1～3d内移植肾功能恢复正常,另2例因供肾迷走血管损伤在术后5d左右血肌酐下降到200μmol/L,1个月左右稳定在160μmol/L。1例他克莫司仅服0.5～0.75mg/d,于术后5个月出现急性排斥反应。1例术后2个月出现环孢素A急性肾毒性(血药浓度谷值为343μg/L)。2例出现药物性肝炎。结论:亲属活体肾移植术较为安全,排斥反应少,结果满意。免疫抑制剂宜采用低剂量方案。

AIM： To review retrospectively the clinical experience of living relative donor kidney transplantation and improve the safety and efficacy of this technique. METHODS： Eighteen patients underwent living relative donor kidney transplantation were enrolled from the 175^th Hospital of Chinese PLA between November 2005 and December 2006. Informed consents were obtained from all the recipients with end-stage renal failure for chronic glomerulonephritis. Their ages ranging from 24 to 74 years, 17 cases were blood relationship donors and 1 case was unrelated donor （wife）. All the subjects underwent open donor nephrectomy, in which 15 cases donated left kidney and 3 cases donated right kidney. Triple-combined immunosuppressive protocols mainly consisting of cyclosporin, mycophenolate mofetU and steroid were adopted for recipients after operation. RESULTS： （1）All donors were discharged about ten days postoperation without serious complications and serum creatinine under normal range. （2）Renal function of 16 recipients recovered to normal levels within 1-3 days postoperation, while serum creatinine of other two recipients were decreased to 200 μmol/L 5 days postoperation and remained 160 μmol/L one month postoperation for aberrant vascular injury of donating kidney. Acute rejection occurred in one patient 5 months postoperation for 0.5-0.75 mg/d Tacrolimus. One patient presented acute allograft renal toxicity for cyclosporin （whole blood concentration was 343 μg/L） in two months. Two recipients complicated with drug-induced hepatitis. CONCLUSION： Living relative donor kidney transplantation presents safety, few rejection and satisfactory results. Low-dose of immunosuppressants are recommended.