夫妻间肾移植效果分析及其伦理问题探讨

Clinical analysis of renal transplantation between husband and wife

目的 探讨夫妻间肾移植术临床应用可行性.方法 10例夫妻间供肾术前全部进入伦理审批准备过程.供肾均采用全麻;妻子供肾6例,丈夫供肾4例;患者术前HLA配型＞3位点匹配,群体反应性抗体（PRA）＜20%;血型A-A 6例,B-B 2例,O-A或B 2例.根据螺旋CT血管成像或肾动脉造影结果,1例因左肾肾动脉有分支,切取右肾,其余9例均切取左肾.术后免疫抑制方案术中MP 1.0 g,术后第1、2天MP 0.5 g,术后第3天环孢霉素A （CsA）6.0 mg/（kg＆#183;d）,霉酚酸酯（MMF）2.0/d,泼尼松30 mg/d,随访CsA根据谷值浓度调整,6个月时MMF 2.0/d,10 mg/d.结果 全部供体顺利度过围术期,术后8-10 d出院,随访观察6个月以上未发现高血压,肾功能正常,能参加正常工作.全部受体均得到随访,10例移植肾在开放血管后1 min内出尿,其中1例妻子供肾受体术后发生加速性排斥反应（AAR）,经应用OKT3 10 d控制排斥,受体患者复查至2010-01移植肾功能正常.结论 夫妻间肾移植伦理反对和心理拒绝少,治疗效果满意.

Objective To study the clinical feasibility of renal transplantation between spouses. Methods Ten cases of cou- ples for kidney patients entered the ethics approval process for the preparation of donor kidney using general anesthesia; wife of donor kidney in 3 cases, the husband for kidney 7 cases; patients with preoperative HLA matching 〉 3 locus matches, panel reactive anti- body （PRA） 〈20% ; A-A blood group in 6 cases, B-B 2 cases, O-A or B in 2 cases; according to the renal vascular examination （spiral CT angiography or renal artery angiography） results, in 1 patient with left renal artery branches, the right kidney was cut, in the other 9 patients the left kidneys were cut. Postoperative immunosuppressive regimen included MP1.0 g, MP0.5 g, after the first two days, after third days of cyclosporin A （CsA） 6.0 rag/（ kg ~ d） （MMF） 2.0/d, mycophenolate mofetil 30 mg/d, CsA followed and adjusted according to the valley value of concentration, on six months MMF2.0/d, 10 mg/d. Results All donors passed through operation, after 8-10 days discharged, followed up for more than 6 months. Not hypertension was found, renal function was normal. They could participate in normal work. All recipients were followed up. In 10 cases of renal transplantation, one min after opening of vessels, there bleeding in urine, including 1 case of wife donor renal receptor after accelerated rejection （ AAR）, to where application of OKT3 10 d controlled the rejection. The receptor patients presented normal graft function by re-examinations till to January 2010. Conclusions Renal transplantation between husband and wife has few ethics opposal and psychological denial, and satisfactory thera- peutic effect.