供肾穿刺活检在亲属活体肾移植中的应用及边缘供肾对受者预后的影响

Applications of renal biopsy in living-related kidney transplantation and the influences of themarginal donor on the recipient prognosis

目的分析供肾穿刺活检在亲属活体肾移植中对供肾质量的诊断价值及边缘供r肾对亲属活体肾移植受者早期预后的影响。方法2004年2月至2008年7月142例亲属活体肾移植患者，按照供体年龄和供肾情况分为边缘供者组（5l例）和非边缘供者组（91例），并对49例亲属活体供肾行细针穿刺活检术。分析2组受者的术后血肌酐（Scr）变化、Scr最低值、所需时间、术后并发症发生率。结果49例亲属活体供肾中13例发生病理改变。边缘供者组受者Scr在术后4周、12周、6月及最低Scr水平均高于非边缘供者组（均P〈O．05），而术后12个月、24个月、36个月Scr和Scr恢复至最低水平所需时间差异无统计学意义（均P〉O．05）。边缘供。肾受者术后并发症发生率与非边缘供肾受者差异无统计学意义。结论边缘供肾受者的早期临床疗效是理想的，但术后血肌酐基线较非边缘供肾患者高，应严格控制其纳入标准。供肾穿刺活检有利于发现常规无创检查难以发现的潜在肾脏疾病，对供受者具有重要诊断和治疗价值。

Objective To analyze diagnostic value of renal biopsy in living-related kidney transplantation and the influence of kidneys from marginal donors on the early prognosis of recipients. Methods According to donors age and risks of donors, 142 living-related kidney transplant recipients from February 2004 to July 2008 were divided into marginal donor group （51 cases） and non-marginal donor group （91 cases）. Renal biopsy was performed on 49 kidneys Postsurgical serum creatinine （Ser）, the lowest Scr and post-transplant complications were analyzed between the two groups. Results Pathological changes were detected in 13 cases. The Scr at 4 weeks, 12 weeks, 6 months post-transplant and the lowest level of Scr in marginal donor group were higher than those in non-marginal donor group （all P〈0.05）. There were no significant differences of Scr levels at 12 months, 24 months, 36 months post-transplant, the time required to return to the lowest Scr, and post-transplant complications between two groups （all P〉0.05）. Conclusions The early clinical efficacy of the marginal donor is ideal, but the baseline of Scr of recipients is higher than that of recipients with kidneys from non-marginal donors. Renal biopsy has an important diagnostic and therapeutic value for both donors and recipients.