亲属肾移植供者术后早期肾功能变化的影响因素

Early postoperative renal function changes and its influence factors in living-related kidney donors

目的:观察亲属肾移植供者所保留肾脏在手术前后肾小球滤过率(GFR)的变化及其影响因素。方法:共入组34例活体亲属肾移植供者,每例供者术前用MDRD公式计算总体GFR(eGFR)。观察供者肾切除后其保留肾脏4月内eGFR变化规律,并观察每例供者术后保留肾脏的代偿率,同时观察性别、年龄、体质量指数(BMI)和术前eGFR水平等因素对代偿率的影响,以术后1月作为观察终点。结果:所有供者肾切除术后保留肾脏的eGFR均逐渐增加,于术后第4天达到高峰,由术前的平均72.40ml/(min·1.73m2)增至平均88.05ml/(min·1.73m2),平均代偿率为21.60%。其中男性供者平均eGFR由术前的64.49ml/(min·1.73m2)增至80.48ml/(min·1.73m2),代偿率为24.79%,女性供者平均eGFR由术前的76.72ml/(min·1.73m2)增加至92.18ml/(min·1.73m2),代偿率为20.15%;≥50岁供者平均eGFR由术前的72.82ml/(min·1.73m2)增加至81.66ml/(min·1.73m2),代偿率为12.14%,<50岁供者平均的eGFR由术前的72.18ml/(min·1.73m2)增加至91.54ml/min,代偿率为26.82%;术前eGFR60ml/(min·1.73m2)供者平均由术前81.95ml/(min·1.73m2)增至95.42ml/(min·1.73m2),代偿率为16.44%,术前eGFR<60ml/(min·1.73m2)供者平均由术前54.90ml/(min·1.73m2)增至74.55ml/(min·1.73m2),代偿率为35.79%;BMI≥23.0kg/m2供者平均eGFR由术前的67.21ml/(min·1.73m2)增至84.39ml/(min·1.73m2),代偿率为25.56%,BMI<23.0kg/m2供者平均eGFR由术前的76.50ml/(min·1.73m2)增加至90.94ml/min,代偿率为18.88%。结论:肾切除术后所有供者保留肾脏的eGFR均明显增加;性别、年龄和术前eGFR水平严重影响肾脏切除术后供者的肾功能恢复;男性和女性供者在肾脏切除术后其保留肾脏的代偿率相似,但男性作为亲属肾移植供者与同龄女性相比术前eGFR水平较低;>50岁供者在术后肾脏的代偿率较低;术前GFR较小和BMI较大的供者,术后其代偿率更高。

Objective：To observe early postoperative renal function changes and its influence factors in livingrelated kidney donors. Methodology： Thirty four cases of living-related kidney donors were enrolled in this study. Estimated glomerular filtration rate （eGFR） was calculated using the abbreviated Modification of Diet in Renal Disease （MDRD） formulae,the GFR of both kidneys was detected using emission computed tomography （ECT） equipment and eGFR of each kidney before surgery was estimated in proportion. The changes of eGFR and compensatory rate of the retained kidney in the first month after donor nephrectomy were observed, and at the same time the influence factors [eg, sex, age, body mass index （BMI） and preoperative eGFR] were exanimated. The endpoint of the study was one month post surgery. Results ： The eGFR of the retained kidney increased gradually and reached a peak at 4 days after surgery. The average eGFR increased from 72.4 ml/（ min. 1.73m2） before surgery to 88.1 ml/（ min-1.73m2） at the endpoint with the average compensatory rate of 21.6%. The eGFR of the male group increased from 64.5 ml/（ min 1.73m2） to 80.5 ml/（ min-1.73m2 ） ,with the compensatory rate of 24. 8% , and the female group from 76. 7 ml/（ min 1.73m2 ） to 92. 2 ml/（min-1.73m2） ,with the compensatory rate of 20. 2%. For donors over the age of 50, the eGFR increased from 72. 8 ml/（ min 1.73 m2） to 81.66 ml/（ min 1.73m2） and the compensatory rate was 12. 14% , and for doners less than 50 years old the eGFR increased from 72. 2 ml/（ min. 1.73m2） to 91.5 ml/（ min. 1.73m2） with the compensatory rate of 26. 8%.For doners eGFR above 60 ml/（min. 1.73m2 ） before surgery, the average eGFR increased from 81.9 ml/（ min. 1.73m2 ） to 95.4 ml/（min. 1.73m2 ） with the compensatory rate of 16.4% , and for doners eGFR below 60 ml/（ min. 1.73m2 ） increased from 54. 9 ml/（ min. 1.73 m2 ） to 74. 6 ml/（ min. 1.73 m2 ）, with the compensatory rate of 35.8 %. For donets BMI above 23.0 kg/m2 before surgery,the average eGFR increased from 67.2 ml/（ min. 1.73m2） to 84. 4 ml/（ min. 1.73m2） , with the compensatory rate of 25.6%, and the eGFR of donors with a presurgry BMI below 23.0 kg/m2 increased from 76.5 ml/（ rain. 1.73m2 ） to 90. 9 ml/（ min- 1.73m2 ）, with the compensatory rate of 18.9%. Conclusion： The eGFR of the retained kidney increased significantly after surgery. The; gender, age and preoperative eGFR were important influence factors on the renal recovery of the retained kidney after nephreetomy. The compensatory rate between male and female donors was similar while male donors had a lower preoperative eGFR. Donors over the age of 50 had lower compensatory rate and donors with lower preoperative eGFR and higher BMI always had higher compensatory rate.