175例亲属活体肾移植临床报告

Living-related kidney transplantation: report of 175 cases

目的分析亲属活体肾移植临床特点,提高肾移植效果。方法2004年1月至2008年12月,共实施175例亲属活体肾移植。供受者之间的关系以父母与子女(36%,63/175)和兄弟姐妹(28%,49/175)为主。175例供者中,50岁及50岁以上52例,镜下血尿4例(其中2例合并高血压),肾结石2例,肥胖供者2例。59例供肾做零点穿刺病理检查,15例发现异常。受者年龄33±10.5岁,原发疾病以肾小球肾炎为主72.6%(127/175),糖尿病肾病和高血压肾病各占4%(7/175)。结果供体术后第7d、第1个月血肌酐分别为102±22.5μmol/L、92±19.1μmol/L。受者1例死于重症肺部感染。2例分别因吻合口狭窄合并急性排斥、移植肾动脉栓塞而切除移植肾。患者和移植肾的1年生存率分别为99.3%、98.2%。加速性排斥发病率1.1%(2/175),急性排斥14.9%(26/175)。其他并发症包括肝功能损害(22.3%)、感染(9.7%)和白细胞减少(4.6%)等,移植肾动脉狭窄发病率2.3%(4/175)。结论我国亲属活体与尸体肾移植受者的原发疾病谱可能不同;术后需注意急性排斥与肾动脉狭窄或吻合口狭窄的鉴别诊断与治疗;边缘供肾制定合理入选标准,可较好用于肾移植;患者和移植肾近期效果良好,远期效果有待进一步研究。

Objective To analyze the clinical characteristics of living-related kidney transplantation （LRKT）. Methods From January, 2004 to December, 2008, 175 LRKT were performed including 63 cases （36%） of parent-child relations and 49 cases （28%） of sibling relations between the recipients and donors. Out of 175 donors, 52 were 50 years old or above, 4 had microscopic hematuria （including 2 with also hypertension）, 2 had kidney stone, and 2 had high body mass index （BMI）. Zero-point graft biopsy was performed in 59 donors, and abnormalities were found in 15 of them. The recipients were at the age of 33± 10.5 years, and the primary diseases are mainly dominant glomerular nephritis （72.6%, 127/175）, and with a few cases of diabetes （4%, 7/175） and hypertensive nephropathy （4%, 7/175）. Results Serum creatinine of the donors was 102± 22.5 μmol/L at 7 days postoperatively, and 92 ± 19.1 μmol/L at one month. One recipient died of severe pulmonary infection. Two recipients underwent graft nephrectomy due to anastomotic stenosis with concomitant acute graft rejection and renal arterial embolism. The one-year survival rates of the patients and grafts were 99.3% and 98.2%, respectively. The incident rates of accelerated rejection and acute rejection were 1.1% and 14.9%, respectively. Other complications included impaired liver function （22.3%）, infection （9.7%） and leucopenia （4.6%）. The renal arterial stenosis occurred in 2.3% （4/175） of the recipients. Conclusions The recipients of living-related and cadaveric kidney transplant have different primary kidney disease spectrums. Differential diagnosis and treatment of acute rejection and renal artery or anastomotic stenosis can be of vital importance. Marginal donor kidneys with appropriate inclusion criteria can be safely used for transplantation. With good short-term patient and graft survival, LRKT needs further study to evaluate its long-term effect.