心脏死亡器官捐献肾移植及顶层设计的初步经验

The experience of kidney transplatation from cardiac death donors and the top-level design

目的总结近年来开展的心脏死亡器官捐献（DCD）肾移植的临床经验,探讨终末期肾病患者接受移植的疗效及顶层设计与实施。方法回顾性分析23例接受DCD肾移植的终末期肾病患者的临床资料。结果23例患者均顺利完成DCD肾移植术。其中17例患者术后第5-7天肾功能恢复正常;4例患者术后第8-10天肾功能恢复正常;2例患者肾功能延迟恢复,其中1例规律血液透析2周后肾功能恢复正常,另1例（最近1例）血液透析2个月后肌酐维持在190μmol/L并出院。随访时间为3个月至2年,1例患者术后第5个月死于重症肺部感染。结论 DCD供肾肾移植效果好,是我国尚无脑死亡法的条件下,有效解决肾移植面临的肾源短缺的重要途径;良好的顶层设计及组织实施是DCD肾移植工作开展的有力保障。

Objective To summarize the recent clinical experiences of kidney transplantation using kidney donated after cardiac death （DCD） , and to investigate the efficacy of kidney transplantation for patients with end - stage renal disease （ESRD） and the top - level design. Methods The clinical data of patients with kidney transplantation with DCD were retrospectively analyzed. Results All operations were successful. Normal renal function was regained in 17 recipi- ents 5 ~ 7 days after surgery, and 4 recipients 8 - 10 days; but the other 2 recipients required hemodialysis treatment. During the follow - up of 3 months to 2 years, 1 recipient died of severe pulmonary infection. Conclusion Kidneys from DCD donors have excellent outcomes and may provide another safe resource to expand the donor pool. The good top - level design is a powerful guarantee to carry out the DCD.