公民逝世后器官捐献肾移植单中心233例临床效果分析

Kidney transplantation from donation after citizens death of 233 cases： one single center experience

目的 探讨公民逝世后器官捐献肾移植的临床效果及改善措施. 方法 回顾性分析我中心2007年2月至2013年8月实施233例公民逝世后器官捐献肾移植的资料,分析术后人/肾存活率和并发症的发生情况,以及其中儿童供、受者肾移植的临床效果. 结果 供者130例,包括本院器官获取组织77例和外院器官获取组织分享53例.受者随访1个月～6年.术后6个月、1年、3年、5年的人/肾存活率分别为99.1％/95.7％、99.1％/95.7％、99.1％/94.5％和98.7％/93.3％.其中198例（85.0％）受者移植肾功能恢复顺利,2例（0.8％）受者发生原发性移植肾无功能,33例（14.2％）受者发生移植肾功能延迟恢复（DGF）.3例受者移植肾带功死亡,6例受者移植肾丢失,28例（12.0％）受者发生肺部感染.儿童供肾肾移植50例,其中10例儿童受者、40例成人受者.1例成人受者发生急性体液性排斥反应,3例成人受者发生急性细胞性排斥反应,经抗排斥治疗后逆转.其中实施小儿双供肾移植手术6例,其中2例发生一侧肾动脉血栓,对侧肾功能均代偿良好.其余4例术后恢复良好.实施儿童受者肾移植21例,其中成人供肾11例、儿童供肾10例.术后2例发生DGF,分别于术后1周和1个月恢复,其余受者移植肾功能顺利恢复;2例受者行移植肾切除术,再次肾移植顺利恢复. 结论 采用多种维护措施公民逝世后器官捐献肾移植可获得较好的中短期移植物存活和肾功能.合理、有效地利用儿童逝世后捐献的供肾,可取得良好的移植疗效.公民逝世后器官捐献体系及器官分配共享政策有助于推进我国儿童肾移植发展.

Objective To explore the clinical effect and improvement measure of kidney transplantation from donation after citizens death in our center.Methods The data of 233 cases of kidney transplantation from 130 citizens death donors from February 2007 to August 2013 in our centre were retrospectively reviewed.Graft function recovery and rejection rate,patient/kidney survival rate and complications,effect of kidney transplantation about pediatric donors and pediatric recipients were analyzed.Results Seventy-seven citizens death donors in our hospital and 53 from other organ procurement organization successfully donated their organs.The recipients were followed up for 1 month to 6 years.The 6-month,and 1-,3-,5-year patient/graft survival rates were 99.1％/95.7％,99.1％/95.7％,99.1％/94.5％ and 98.7％/ 93.3％.Primary non-function occurred in 2 recipients （0.8％）,delayed graft function （DGF） occurred in 33 recipients （14.2％）.Three recipients died with the graft function.There were 6 cases of nephrectomy and 28 cases with pulmonary infection.Fifty patients received pediatric kidney allografts; ten were pediatric recipients and 40 were adults.Acute humoral rejection occurred in 1 adult recipient and acute cellular rejections occurred in 3 recipients.All the 4 patients were reversed after anti-rejection therapy.Six cases of en bloc kidney transplantations were performed,including 2 cases of thrombosis in one renal artery after transplantation.Twenty-one pediatric recipients underwent kidney transplant,including 11 kidneys from adult donors and 10 from pediatric donors.DGF occurred in 2 patients after transplant.Conclusions Well shortterm and medium-term outcomes can be achieved in kidney transplant from donation after citizens death by using a variety of measures to recover the kidneys.Rational using of pediatric donation organ could result in excellent outcome of transplantation.The policy of organ allocation and sharing for organ from donation after citizens death could contribute to the development of pediatric renal transplantation.