活体供肾与尸体供肾:1个器官移植中心2年65:169例肾移植效果比较

Living related donors versus cadaveric donors: Transplantation effect of 65:169 cases in the same center within 2 years

背景:活体供肾移植的数量在部分医院已经超过尸体供肾移植,但其安全性、优越性、手术技巧、其所面临的伦理学问题还有待进一步探讨。目的:回顾总结同期完成的活体供肾移植及尸体供肾移植的临床经验,分析不同肾脏来源的肾脏移植术后疗效。方法:收集2006-01/2008-03在解放军第309医院全军器官移植中心接受活体供肾移植的65例受者、接受尸体供肾移植169例受者的临床资料,对不同肾脏来源受者的性别、年龄、HLA位点配型、手术情况、术中和术后近、远期并发症、免疫抑制方案、肾功能恢复情况及长期随访资料进行对照研究,进一步明确活体亲属供肾移植的临床意义。结果与结论:65例活体供肾移植手术均获成功,人/肾1年存活率为100%;尸体供肾移植手术成功,2例因术后3个月出现脑出血等非感染并发症死亡,6例在术后1年内因重症肺部感染呼吸衰竭死亡,人/肾1年存活率95.26%。两种不同来源的肾脏移植在并发症以及人/肾1年存活率等指标上活体供肾移植优于尸体供肾移植。活体供肾移植等待时间短,组织配型好,供肾缺血时间短,排斥反应发生少,移植肾存活率高,是一种安全可行的治疗手段。

BACKGROUND： The number of living donor kidney transplantation is greater than that of cadaveric kidney transplantation in some hospitals, however, the safety, superiority, surgical techniques, as well as the ethical issues of living donor kidney transplantation needs further explored. OBJECTIVE： To analyze the outcomes of kidney transplantation with different sources of kidney by reviewing clinical experience of the living donor and cadaveric donor kidney transplantation at the same periods. METHODS： Totally 65 cases received living donor kidney transplantation and 169 cases received cadaveric kidney transplantation from January 2002 to March 2008 in the Organ Transplantation Center, 309 Hospital of Chinese PLA, were collected. The data of recipients with different kidney sources, including gender, age, human leucocyte antigen-matching, surgery status, complications, immunosuppression scheme, kidney function and long-term follow-up were comparatively studied to clarify the clinical significance of living donor kidney transplantation. RESULTS AND CONCLUSION： All 65 cases of living donor kidney transplantation were successful, and the 1-year patient/graft survival rate was 100%.Cadaveric donor kidney transplantation was successful, 2 of which died of cerebral hemorrhage disease, 6 died of severe lung infection after 1 year, and the 1-year patient/graft survival rate was 95.26%. The living donor kidney transplantation was superior to the cadaveric donor kidney transplantation in complications and 1-year patient/graft survival rate and other factors. Living donor kidney transplantation provides a reliable means for patients with full preparation, good matching, few postoperative complications, and high patient/graft survival rate.