亲属活体肾脏移植117例分析

Living related donor kidney transplantation： analysis of 117 cases

目的总结117例亲属活体肾移植临床经验。方法全部供、受者为3代以内血缘关系；供肾均采用开放式手术取肾；全部受者术后采用环孢素A（或他克莫司）、霉酚酸酯（或硫唑嘌呤或咪唑立宾或雷帕霉素）及泼尼松预防排斥反应。结果术后2例发生肾功能延迟恢复；18例发生急性排斥反应，经甲泼尼龙或抗淋巴细胞球蛋白治疗后逆转。术后随访1～44个月。所有受者人肾存活率100％。117名供者术后安返社会；生活、工作未受明显影响，肾脏功能正常；2名供者术后2年内出现高血压，1名出现隐性糖尿病，目前病情平稳。结论术前对供者身、心健康充分评估和积极调节受者身体状况是亲属活体肾脏移植成功的保障。减少移植肾受损、术后早期足量应用免疫抑制剂是减少术后急性排斥反应的关键。

Objective To summarize the clinical experience in living related donor kidney transplantation. Methods 117 patients with different nephropathies underwent transplantation of kidneys donated by their collateral relative in three generations. All donor kidneys were removed by open nephrectomy. Immunosuppressive protocols which consisting of cyclosporine A/tacrolimus, mycofenolate mofetil/azathioprone/rapamycin, and steroid were used in all patients as immunosuppressors. Follow-up was conducted for 1 -44 months. Results Delayed graft function recovery occurred in 2 patients. Acute rejection episodes occurred in 18 patients, and the condition was reversed by high intravenous dose of methyl-prednisolone or polyclonal anti-T-cell antibodies. Follow-up showed that all the patients survived with normal kidney function, and the donors kept good kidney function with normal life quality. Hypertension was found in 2 donors and diabetes mellitus was found in 1 donor. Conclusion Careful evaluation of both psychological and physical status of the donors and optimal physical status of recipients before operation are critical for successful kidney transplantation. Injury of graft kidney should be reduced and recipients should be treated with sufficient immunosuppressive regimen in early stage after transplantation.