亲属活体肾移植供者留存肾代偿性改变的临床研究

Clinical research on compensatory changes in the retained kidney after nephrectomy in living related donors

目的探讨亲属活体供者在供肾摘取后留存。肾的形态、功能和血流动力学相关指标等方面的代偿性改变，评价留存肾的状态和活体供肾的安全性。方法选择2007年11月至2013年1月170例亲属活体供肾移植的供者，监测术前、术后1个月和术后1年留存肾的肾脏各径长度、肾功能和血流动力学各相关指标的变化，作自身前后的对照研究。选择的指标包括肾脏长径、宽径、短径；留存肾肾小球滤过率（GFR）、有效肾血浆流量（ERPF）；留存肾主动脉（MRA）、段动脉（SRA）及叶间动脉（IRA）的收缩期最大血流速度（Vsmax）、阻力指数（RI）及搏动指数（PI）等。结果170例供者随访9～68个月，无一例发生高血压、肾功能衰竭等。留存肾在对侧供肾切取术后1个月和1年后，肾脏的长径、宽径和短径的长度均较术前显著增加（P〈0．01），而术后1年和术后．1个月相近（P〉0．05）。GFR和ERPF较术前显著增加（P〈0．01），而术后1年和术后1个月相近（P〉0．05）。留存肾MRA、SRA和IRA的Vsmax也较术前显著增快（P〈0．01），RI和PI较术前增加（P〈0．05），但术后1年和术后1个月相近（P〉0．05）。结论活体肾移植供者在单侧供肾摘取后，留存肾的各径长度代偿性增加；GFR和ERPF代偿性增加；各级动脉的血流参数也出现代偿性改变。在严格供者纳入标准的情况下，亲属活体。肾脏供者是安全的。

Objective To investigate the compensatory changes in morphology, function, and hemodynamic indices of the retained kidney after nephrectomy among living related donors. Method The 170 living related kidney donors underwent assessments before surgery as well as at 1st and 12th month, postoperatively, including length, width, short diameter, glomerular filtration rate （GFR）, effective renal plasma flow （ERPF）, peak systolic blood flow velocity （Vsmax）, resistance index （RI）, as well as pulsatility indices （P!） of main renal artery （MRA）, segmental renal artery （SRA）, and interlobar renal artery （IRA）. Results All subjects were followed up for 9 to 68 months, with no observed hypertension or kidney failure. The length, width, and short diameters of the retained kidney were increased significantly （P^0. 01） at 1st and 12th month postoperatively. The renal sizes at 1st month postoperation were similar to that at 12th month postoperation （P^0. 05）. GFR and ERPF were increased significantly as compared with preoperative values （P%0. 01） with similar values at postoperative month 1 and 12 （P^0. 05）. The Vsmax of MRA, SRA, and IRA in the retained kidney were increased significantly （P%0. 01）, and the RI and PI were also increased as compared with the preoperative values （P%0. 05）, albeit these indicators were similar at postoperative months 1 and 12 （P^0. 05）. Conclusion For all subjects studied after unilateral nephrectomy in a living related donor, the diameter of the retained kidney as well as the GFR and ERPF showed compensatory increases. Various arterial hemodynamic parameters also showed compensatory changes. Under strict donor inclusion criteria, living related kidney donor procedures is safe.