219例活体肾移植供者长期随访分析

Long-term results of 219 living kidney donors

目的探讨活体肾移植供者术后生存质量及恢复情况。方法对2004年以来219例肾脏捐献超过1年的亲属活体肾移植供者进行随访，评估供者的肾功能、并发症发生情况及生活质量。结果供者捐肾时年龄为（43．3±11．6）岁（19-66岁），随访时间为术后12～103个月，随访截止时供者存活率为100％。术后稳定期（1年后）供者血清肌酐（Scr）为（84．0±18．7）μmol／L，内生肌酐清除率（Ccr）为（1．23±0．37）ml／s。〉50岁者术后1周及1年后Ccr低于年龄≤50岁者（P〈0．01，P〈0．05）。3例供者术后Scr未降至正常范围，其肾脏捐献时年龄〉55岁。术后并发症包括高血压30例（其中5例为术后新发），镜下血尿4例，高脂血症3例，轻度贫血2例，股骨头坏死1例。总体感觉肾脏捐献对健康有影响者共40例，认为肾脏捐献对健康有轻度影响者31例，有较明显影响者7例，有严重影响者2例；偶尔觉伤口疼痛31例，经常感觉伤口疼痛4例。结论供者肾脏捐献后中长期安全性和生存质量良好，但仍存在肾功能异常风险，尤其是高龄供者，需密切随访。供者随访依从性需进一步提高。

Objective To document retrospectively long-term quality of life （QOF） and safety of living kidney donors. Methods A total of 219 living-related kidney donors which can be followed up had donated their kidneys between May 2004 and Sep. 2011. The renal function, complications and QOF were estimaged. Results Donors included 104 men and 115 women with age from 19 to 66 years. Follow-up period was from 12 to 103 months. No cases died. The mean serum creatinine （Scr） was （84. 0± 18. 7） vmol/L and creatinine clearance （Ccr） was （1. 23 ± 0. 37） ml/s over 12 months postoperation. The average Ccr was lower in donors age over 50 years than in younger donors. The kidney function was still abnormal in 3 elder donors at end of the study. Thirty donors had hypertension including 5 newly cases. Microscopic hematuria was found in 4 cases. Hyperlipidemia developed in 3 cases. Mild anemia occurred in 2 cases. Femoral head necrosis occured in 1 case. Majority of 18. 26% donors （40 cases） reported weak healthy feeling （mild impact in 31 cases, moderate impact in 7 cases and severe impact in 2 cases）. Thirty-five donors reported mild pain of incision （31 cases occasionally, and 4 cases frequently）. Conclusion Living kidney donors have good long-term QOF and safety though there still exist risks of renal impact. Close follow-up is required especially in elderly donors. Compliance of donors needs to be further improved.