伴急性肾功能衰竭的脑死亡器官捐献供者供肾移植26例报告

Kidney transplantation from brain death donors with terminal acute renal failure： a report of 26 cases

目的探讨急性肾功能衰竭（ARF）的脑死亡器官捐献（DBD）供者供肾移植的效果。方法回顾性分析DBD供者中标准供者供肾移植的临床资料，分析其中合并ARF的供者供肾移植（ARF组）效果，并与正常肾功能供者供肾移植（对照组）比较。结果ARF组供者13例，对照组27例。ARF组供者终末血肌酐水平显著高于对照组[（394．9±176．8）μmol／L和（75．4±28．6）μmol／L，P〈0．001]，但两组供者间初始血肌酐水平[（79．1±17．2）μmol／L和（71．0±22．8）μmol／L]和最大肌酐清除率[（128．3±33．0）ml／min和（129．8±46．8）ml／min]的差异并无统计学意义（P〉0．05）。ARF组受者26例，对照组受者54例，两组术后移植肾恢复延迟发生率分别为0和1．9％（1／27），急性排斥反应发生率分别为11．5％（3／27）和7．4％（4／54），均无显著差异（P〉0．05）。ARF组受者术后1个月估算。肾小球滤过率（eGFR）为（54．3±16．9）ml·min-1·1．73m-2，显著低于对照组受者的（62．5±14．2）ml·min-1·1．73m-2（P=0．025），但术后6个月和12个月时两组受者间eGFR的差异并无统计学意义（P〉0．05）。随访3～28个月，两组受者和移植肾存活率均为100％。结论合并ARF的DBD供者供肾移植术后的近期效果良好，是扩大供肾来源的潜在途径。

Objective To explore the effect of kidney transplantation from donation after brain death （DBD） donors with terminal acute renal failure （ARF）. Method The clinical data of kidney transplantation from DBD donors with ARF were retrospectively analyzed, and only standard criteria donors （SCD） were included. The results of kidney transplants from ARF donors were compared with those of kidney transplants from DBD donors with normal renal function （serum creatinine （133 μmol/L） performed from January 2012 to March 2014. Result There were 13 donors with ARF and 27 donors with normal renal function （non-ARF donors）. The ARF donors had significantly higher terminal serum creatinine than the non-ARF donors （394. 9± 176. 8 vs. 75.4 ± 28. 6 μmol/L, P〈0. 001）, but the initial serum creatinine （79. 1 ±17. 2 vs. 71.0 ± 22. 8μmol/L） and the best creatinine clearance rate （128. 3± 33. 0 vs. 129. 8 ± 46. 8 ml/min） of two groups showed no significant difference （P〉0. 05）. Twenty-six recipients received kidney transplants from ARF donors （ARF group） and 54 recipients received kidney transplants from donors with normal renal function （non-ARF group）. There was no significant difference in the incidence of delayed graft function and acute rejection between ARF and non-ARF kidneys （0 vs. 1.9%, and 11.5% vs. 7. 4%, respectively）. The ARF group had significantly lower estimated glomerular filtration rate （eGFR） .at 1st month after transplantation （54. 3 ± 16.9 vs. 62.5 ＋- 14. 2 mL-min-11.73 m-2 , P = 0. 025）, but the eGFRs of two groups were similar at 6th and 12th month after transplantation. During a mean follow-up period of 11.5 months （range 3 to 28 months）, actual patient and graft survival rate for both groups were 100%. Conclusion Kidneys from DBD donors with terminal ARF have excellent short-term outcomes and may represent another potential method to safely expand the donor pool.