心脏死亡供者供肾移植14例报告

Kidney transplantation from donation after cardiac death donor

目的总结心脏死亡供者供肾的获取以及应用于临床肾移植的经验。方法共7例心脏死亡供者捐献了供肾，进行了14例肾移植。7例供者年龄30-53岁，原发病为脑出血3例，颅脑外伤2例，脑基底动脉闭塞1例，颅脑肿瘤卒中1例；威斯康辛大学评分为19-23分，均为高危组。7例供者的所有近亲家属签署器官捐献知情同意的相关文件。临床评估供肾良好，供者心脏停跳2～5min后确定为心脏死亡，并采用腹腔多器官联合快速切取技术获取双侧肾脏。14例受者与供者HLA抗原错配数为2～4个，受者淋巴细胞毒交叉配合试验≤0．05，群体反应性抗体〈10％。7例供者中有6例的热缺血时间为5～10min，1例为45min；冷缺血时间为4．5～12．5h。结果利用心脏死亡供者供肾的14例肾移植手术均顺利完成。14例受者中，术后发生原发性移植肾无功能（PNF）1例，移植肾功能恢复延迟（DGF）3例，急性排斥反应2例；其中1例因PNF在术后第1天切除了移植肾，并恢复规律血液透析，1例因DGF仍在恢复中（尚处于术后3个月），血清肌酐149umol／L，该2例受者均接受了热缺血时间为45min的供肾；其余12例受者痊愈出院，移植肾功能均良好。结论遵照《中国心脏死亡器官捐献指南》开展心脏死亡器官捐献工作，维护好潜在供者的各项重要生命指标，可以保证供肾质量；心脏死亡供者供肾可作为肾移植的重要器官来源，并且移植效果良好。

Objective To summarize the clinical experience of harvesting and using the kidneys from donation after cardiac death （DCD） donors. Methods Fourteen kidney transplantations were successfully performed on 14 patients with end-stage renal diseases. The kidneys were harvested from 7 volunteer donors （age 30-53 years） diagnosed with cardiac death, who were scored 19-23 according to the University of Wisconsin donation after cardiac death evaluation. Primary diseases of the donors were cerebral hemorrhage, brain injury, ischemic cerebral vascular disease and brain tumor. Warm ischemia time ranged from 5 to 45 min, and cold ischemia time was 4. 5 - 12. 5 h. Results After transplantation, three patients had delayed graft function （DGF）, one had primary non-function （PNF）, and two patients developed acute rejection. In the patient with PNF, the transplanted kidney was removed one day after operation and the patient went back to hemodialysis. One patient with DGF was still in recovery with serum creatine 149 umol/L （within 3 months after operation）. The above two cases both utilized the kidneys with 45 min of warm ischemia time. The rest 12 patients were discharged with normal renal function. Conclusion Under the condition of our country, kidneys strictly harvested from DCD donors can be used as one of the main sources of kidney grafts for kidney transplantation.