老年亲属供肾肾移植临床效果分析

Clinical effects of kidney transplantation from elderly living-related donors

目的了解老年人供肾亲属肾移植临床效果。方法回顾性分析我院肾移植科2005年11月至2011年6月亲属活体肾移植的临床资料，按供者情况分为老年亲属供肾组36例（老年组），非老年亲属供肾组208例（非老年组）。比较两组受者术后3d、7d、1个月、3个月、6个月、12个月、24个月、36个月血肌酐（SCr）水平和外科并发症、急性排斥、钙调磷酸酶抑制剂（CNI）肾毒性、移植肾功能延迟（DGF）发生率，并观察1年、3年人和（或）肾存活率。结果老年组受者SCr术后3d为（245．2±135．2）μmol／L、7d为（150．5±86．8）μmol／L、1个月为（140．6±42．5）μmol／L，高于非老年组的（185．6±148．4）μmol／L、（122．2±136．8）μmol／L、（117．8±33．2）μmol／L（分别为t=84．07、31．90、21．54，均P=0．000）；CNI肾毒性发生率分别为22．2％（8／36）、1．9％（4／208），差异有统计学意义（X2=27．04，P=0．000）；但两组受者术后3个月、6个月、12个月、24个月、36个月SCr水平和外科并发症、急性排斥、DGF发生率及1年、3年人和（或）肾存活率比较，差异无统计学意义（均P〉0．05）。结论术前对老年供者进行严格筛选和综合评估，健康老年人亲属供者不应作为供者禁忌；但对老年人供肾亲属肾移植受者应注意CNI肾毒性。

Objective To analyze clinical outcome of kidney transplantation from elderly livingrelated donors. Methods The clinical data of living-related kidney transplantation between November 2005 to June 2011 in the First Affiliated Hospital of Zhengzhou University were retrospectively analysed. The patients were divided into elderly donor kidney transplantation group （elderly group, 36 cases） and non-elderly living related donor kidney transplantation group （nonelderly group,208 cases）. The mean recipients serum creatinines before and 3 days, 7 days, 1 month, 3 month, 6 month, 12 month, 24 month, 36 month after surgery, peri-operation complications, the incidence rate of acute rejection, calcineurin inhibitor （CNI）-induced renal toxicity, delayed graft function（DGF）, 1 year and 3 year recipient/kidney survival were compared respectively between the two groups. Results The serum creatinine levels were higher in elderly group than in non-elderly group at 3 days, 7 days, 1 month after surgery [（245.2±135.2）μmol/L vs. （185.6±148.4）μmol/L, （150.5±86.8）μmol/L vs. （122.2±136.8）pmol/L, （140. 6±42. 5）μmol/L vs. （117.8± 33.2）μmol/ L, t= 84.07,31.90,21.54; all P = 0. 000] In addition, the incidence rate of CNI induced renal toxicity was higher in the elderly group than in non-elderly group [22.2% （8/36）vs. 1.9% （4/208）, X2=27.04,P=0. 000]. Nevertheless, there were no significant differences between the two groups in recipients＇ serum creatinines before and 3 month, 6 month, 12 month, 24 month, 36 month after surgery, in peri-operation complications, the incidence rate of acute rejection, delayed graft function, and in 1 year and 3 year recipient/kidney survival （all P~ 0.05）. Conclusions With stringent screening and overall assessment of elderly donors, healthy elderly donors should not be barriers to organ donation. Renal toxicity of CNI agents should be carefully monitored in recipients of elderly donor.