心脏死亡器官捐献供肾与传统尸体供肾肾移植的疗效比较

Comparison of long-term efficacy and complications after kidney transplantation between donors after cardiac death and traditional deceased donors

目的比较心死亡器官捐赠（DcD）供肾与传统尸体供肾肾移植的疗效。方法回顾性分析单中心2007年2月至2012年6月的69例DCD供肾肾移植受者的资料，并根据受者年龄（相差10岁以内）、移植次数和免疫抑制剂应用情况，按1：2的比例匹配同期138例传统尸体肾移植受者，进行资料比较。结果DCD肾移植组术后移植肾功能恢复延迟（DGF）和原发性移植肾无功能（PNF）的发生率为29．0％和2．9％，而传统尸体肾移植组为13．8％和0，差异有统计学意义（P〈0．05）。Kaplan-Meier分析结果表明，DCD肾移植组术后6个月、1年和3年的移植肾存活率分别为95．7％、95．7％和93．3％；而传统尸体肾移植组分别为97．8％、97．8％和96．8％，两组的差异无统计学意义（P〉0．05）。两组受者存活率的差异也无统计学意义（P〉0．05）。术后7和14d，DCD肾移植组的移植肾肾小球滤过率低于传统尸体肾移植组（P〈0．05），但术后1个月至1年，两组移植肾肾小球滤过率的差异无统计学意义（P〉0．05）。结论虽然术后DGF和PNF发生率较高，但DCD肾移植的长期疗效与传统尸体肾移植相当，DCD供肾可以作为替代传统尸体供肾的良好来源。

Objective To compare the long-term efficacy and complications after kidney transplantation between donors after cardiac death （DCD） and traditional deceased donors. Method We retrospectively analyzed 69 cases of DCD kidney transplantation performed in our hospital from February 2007 to June 2012, and compared with 138 cases of traditional deceased kidney transplantation performed in our hospital at the same time, with 1：2 ratio matching according to recipient age （difference less than 10 years）, times of transplantation, and immunosuppressive regimen. Results The incidence of DGF and PNF was 29. 0% and 2. 9o/00 in DCD group,and that was 13. 8% and 0 in traditional deceased donor group （P〈0. 05）, respectively. Kaplan-Meier analysis showed that 6-month, 1- and 3-year graft survival rate was 95.7%,95.7% and 93.3% in DCD group, and that was 97. 8%, 97. 8% and 96. 8% in traditional deceased donor group, respectively. There were no differences between these two groups. There were also no differences in survival of the patients between these two groups. The eGFR level in DCD group was significantly lower in DCD group than in with traditional deceased donor group on the postoperative day 7 and 14,but there were no differences in eGFR levels one month post-operation. Conclusion The long-term efficacy of DCD donors is similar to traditional deceased donors despite of higher DGF rate after transplantation. DCD donors can be good substitute for traditional deceased donors.