亲属活体肾移植供者的选择和安全性评估(附79例报告)

Selection and safety of donor in living-related donor renal transplantation: a report of 79 cases

目的探讨亲属活体肾移植供者的选择评估及围手术期安全性。方法 2007年6月至2010年8月,广西中医学院附属瑞康医院移植泌尿外科严格按照供体的评估程序,对79例拟行亲属活体肾移植的供体进行评估,依据供者入选和剔除标准选出合格供体。所有患者均签署知情同意书,符合医学伦理学规定。对供、受者的临床资料进行回顾性分析。收集供者的一般资料、肾功能、捐献关系,分析拟供者剔除的原因,了解供、受者的配型、手术情况,追踪供者、受者术后随访情况。结果 79名拟供者,经严格的筛选最终确定为亲属活体肾移植供体38名。剔除的41例中,糖尿病和高血压,占34%,其余依次为双侧肾功能损害、患乙型病毒性肝炎或丙型病毒性肝炎。供、受者的关系:父母捐献给子女15名,3代以内血亲捐献10名,兄弟之间捐献8名,夫妻之间捐献5名。供、受者血型相同33对、相容5对。供、受者补体依赖淋巴细胞毒性试验均为(-)、群体反应性抗体均为(-)。供者手术时间1～2h,供肾热缺血时间30～60s,冷缺血时间1～2h。供者术前及术后的血清肌酐水平都有不同程度的升高,但均于术后7d恢复正常。供者围手术期间均未发生外科及内科并发症,住院时间10～14d。本组受者中,除1例夫妻之间捐献的肾移植患者术后发生急性排斥反应外,其他病例无出现急性排斥反应、肾功能延迟恢复等状况,随访至2010年7月,移植肾均正常。结论对于亲属活体肾移植的供体安全应予重视。严格进行术前评估,选择合格的供者,术中操作规范,术后加强管理,活体肾移植的供者围手术期是安全的。

Objective To evaluate donor selection and perioperative safety in living-related donor renal transplantation. Methods Seventy-nine potential donors for living-related renal transplantation were strictly evaluated by donor assessment protocol from June 2007 to August 2010 in Department of Transplantation and Urology Surgery in Affiliated Ruikang Hospital of Guangxi Chinese Traditional Medicine College. Qualified donors were selected according to inclusion and exclusion criteria. The Medical Ethics Committee approved the protocol, and informed consent was obtained fi＇om all the donors and recipients. Clinical data of donors and recipients were retrospectively analyzed. General data, renal function of donors and relationship between donor and recipient were collected to analyze the reason for donor exclusion. Type-matching and operation condition of donors and recipients were recorded. Donors and recipients were followed up after operation. Results Seventy- nine potential donors were strictly evaluated by donor assessment protocol and 38 were identified as living- related donors for renal transplantation. For 41 excluded donors, the main reasons for exclusion were diabetesand hypertension （34%） , and bilateral renal damage, hepatitis B or hepatitis C. Donor-recipient relationship included parent to child （ n = 15 ） , collateral relative in 3 generations （ n = 10 ） , brother （ n = 8 ） and couple （n = 5 ）. Blood type between donor and recipient was same in 33 pairs and compatible in 5 pairs. The complement-dependent cytotoxicity and panel reactive antibody were both negative in donors and recipients. The operation time of all donors was 1-2 hours, the warm and cold ischemic time of donor kidney was 30- 60 s and 1-2 hours respectively. The serum ereatinine （Scr） level of donors increased before and after operation, but decreased to nol^aa] at 7 d after the operation. Neither surgical nor medical complication occurred in all donors during perioperative period with 10-14 days of hospitalization. Except one reeipient who was donated by couple developed acute rejection, no acute rejeetion or delayed graft function occurred in other recipients. The transplant kidney worked normally till the end of this follow up by July 2010. Conclusions Attention should be paid to the safety of donor in living-related donor renal transplantation. The donor will be safe during perioperative period if the potential donor is strictly evaluated for qualified donor selection, the operation suceeeds and the donor is treated properly after operation.