夫妻间供肾移植10例报告

Spousal renal donor transplantation:a report of 10 cases

目的总结夫妻间供肾移植的临床经验。方法回顾性总结了我院2004年4月至2008年4月10例夫妻间供肾移植的临床资料。供者男5例,女5例。年龄32～62岁(42.0±10.0)岁。5例行手助腹腔镜取肾,5例行小切口开放取肾。受者年龄32～61岁(43.3±9.13)岁,术后采用三联免疫抑制方案:环孢素A/FK506+骁悉/硫唑嘌呤+泼尼松预防排斥反应。10例患者随访3～40月。结果手术成功率100%,供受者无一例发生手术相关并发症。10例供者术后1周内血肌酐较术前升高15%～25%,但均维持正常水平。随访超过1年的7例供者,肾功能均维持正常。受者术后发生急性排斥反应1例,主要归因于未遵医嘱服用免疫抑制剂,术后3月并发肺部感染死亡。发生移植肾功能延迟恢复1例,治疗2周后肾功能恢复正常。其余8例患者肾功能完全恢复正常的平均时间为3.61天。10例受者术后血肌酐恢复正常的时间、急性排斥和移植肾功能延迟恢复的发生率与同期的亲属肾移植组相比均无显著性差异。结论夫妻间供肾移植安全可行,效果良好。

Objective To summarize the clinical experience in spousal renal donor transplantation. Methods A retrospective analysis of 10 recipients receiving spousal renal donor transplantation from April 2004 to April 2008 was performed. Live donors （male 5, female 5） with mean age （42.0 ±10. 0） years old underwent fully medical evaluation before operation. Five donors received hand-assisted laparoscopic donor nephrectomy and 5 cases underwent open approach nephrectomy through a small incision. The mean age of recipients was （43.3± 9.13） years old. Triple-combined immunosuppressive agents were used postoperatively consisting of cyclosporine A/FK506, MMF/azathioprine and steroids. All recipients were followed up for 3 - 40 months. Results All operations achieved totally success. None suffered surgical complications. The donors experienced a transient rise in serum creatinine （15 % - 25 %）, but still within normal range. Seven donors who were followed for more than 1 year maintained normal kidney function. One recipient was complicated with acute rejection due to poor medical compliance and died from pneumonia at 3 months after kidney transplantaion. One recipient suffered delayed graft function （DGF） and recovered to normal 2 weeks later. The renal function of the other 8 recipients got fully recovered to a normal level at mean time of 3.61 days. There was no significant difference in the recovery time while the serum creatinine returned to the normal level, acute rejection and DGF between spousal donor transplantation recipients and genetically related living donor allograft recipients. Conclusions Spousal-donor kidney transplantation is proved to be safe and feasible, as well as good outcome.