高龄和潜在医学风险的活体供者肾移植的安全性分析

Safety of living donor kidney transplantation in elder donors or with potential medical risks

目的探讨存在高龄及潜在医学风险的活体肾移植供者的选择和安全性问题。方法本院亲属活体肾移植供者66例，按年龄分为〈50岁组（42例）和≥50岁组（24例）。按术前检查分成存在潜在医学风险组12例（A组）和一般供者组54例（B组）。对供者住院时间、手术前后肾小球滤过率（GFR）、血清肌酐（Scr）、并发症等情况进行比较分析。结果〈50岁组和≥50岁组手术前后的Scr和术前总GFR差异无统计学意义（P〉0．05），但术后3个月留存肾GFR分别为（74．82±17．42）、（60．34±13．32）ml／min（P〈0．05）。55岁以上供者术后平均住院时间长于〈50岁组供者（P〈0．05），而2组总并发症发生率差异无统计学意义（P〉0．05）。A、B2组比较，术前总GFR，手术前后Scr，术后3个月以上留存肾GFR差异均无统计学意义（P〉0．05）。结论对于存在高龄或潜存医学风险供者选择需十分谨慎。术前全面评估，严格控制纳入标准，其预后和安全性良好。

Objective To investigate the selection and safety of living kidney transplantation in elder donors or with potential medical risks. Methods A retrospective analysis of 66 living kidney donors in our hospital was performed. The donors were stratified into aged below 50 years group （n=42） and aged 50 years or above group （n=24） based on their age, and also into potential-risk group （group A, n=12） and non- risk group （group B, n=54） based on pre-operative evaluation. The length of hospital stay, pre- and post- operative glomerular filtration rate （GFR）, serum creatinine （Scr） and complications were compared among the donors. Results The pre-operative GFR and pre-and post-operative Scr appeared to be comparable between the age-stratified groups （P〉0.05）. However, the 3-month post-operative GFR of the remaining kidney was （74.82± 17.42） ml/min in the aged below 50 years old group vs （60.34± 13.32） ml/min in the aged 50 years or above group （P〈0.05）. Donors aged above 55 years required longer hospital stay compared with those aged below 50 years （P〈0.05）. There was no significant difference in incidence of complications between the two groups （P〉0.05）. The risk-stratified groups showed similar levels of pre- and post-operative Scr, pre-operative and 3-month post-operative GFR （P〉0.05）. Conclusions Selection of donors with advanced age or potential medical risks need to he careful. Comprehensive evaluation bofore operation and rigorous criteria of inclusion should ensure good safety and favorable outcomes.