亲属活体供肾与同期尸体肾移植40例比较

Living-relative donor kidney transplantation versus cadaveric renal transplantation in 40 cases

背景:近年亲属活体间肾移植数量明显增加,供肾者的安全性及亲属活体供肾的移植质量受到日益重视。目的:总结40例亲属活体供肾移植的临床经验,评价其效果及安全性。方法:广西中医学院附属瑞康医院移植泌尿外科在2007-06/2008-08共完成亲属活体供肾移植40例,回顾分析供、受者相关的临床资料。同期随机抽取尸肾移植40例,将亲属活体间肾移植受者与尸肾移植受者在血肌酐水平恢复正常时间、急性排斥反应发生率、肾功能延迟恢复发生率、外科相关并发症发生率等方面进行比较。结果:所有供者手术时间仅1.0～2.0h,供肾热缺血时间15s左右,冷缺血时间1.0～2.0h,围手术期间未发生外科及内科并发症。受者术后肾功能恢复快,前3d尿量500～1000mL/h,1周左右血肌酐水平均可降至正常。随访至今,所有供、受者均正常生存,移植肾功能均保持在正常范围。活体肾移植受者在血肌酐水平恢复正常时间、急性排斥反应发生率、肾功能延迟恢复发生率等方面均显著低于尸肾移植。开放切取供肾手术时间短、热缺血时间短,在手术安全性方面也有一定的优势。

BACKGROUND： It arouses increasing attention on the safety of donors and the transplant results with the growth of living-relative donor kidney transplantation. OBJECTIVE： To summarize the clinical experiences of 40 cases with living-relative donor kidney transplantation and to evaluate the effect and reliability. METHODS： Totally 40 cases received living-relative donor kidney transplantation at the Department of Transplantation and Urinary Surgery, Ruikang Hospital Affiliated to Guangxi Chinese Traditional Medicine College from June 2007 to August 2008 were included. The relevant clinical data of the donors and the recipients were reviewed and analyzed. Meantime, 40 cases received cadaveric renal transplantation at corresponding time period were selected as controls. The differences of recovery times of serum creatinine, occurrence rates of acute rejection, delayed graft function, related complication were compared. RESULTS AND CONCLUSION： The operating times of all donors were 1.0-2.0 hours, the warm ischemic time of donor kidney was about 15 seconds, and the cold ischemic times were 1.0-2.0 hours. No surgical complication and medical complication occurred during the peri-operation period. The kidney function of recipient recovered rapidly after operation. The urine volume in the first three days was 500-1 000 mL/h, and all of the creatinine levels could be restored to normal in 1 week. Up till now, all donors and recipients survived. Moreover, the functions of transplanted kidney were in normal range. Compared with the 40 cases with cadaveric kidney transplantation in the same period, the donors of living-relative donor kidney transplantation have more advantages in the following aspects： shorter recover time for creatinine, lower occurrence rates of acute rejection and delayed graft function after transplantation. Moreover, the living-relative donor kidney transplantation is charactered by shorter ischemic time of donor kidney and operative duration. The open operation in living donor nephrectomy also has the advantage of reliability.