心脏死亡器官捐献肾移植及顶层设计的初步经验

Top-level design and kidney transplantation from cardiac death donors

目的：总结近年来开展的心脏死亡器官捐献（donation after cardiac death,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2011年10月至2013年9月接受DCD肾移植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（73.91%）;4例患者术后第8~10天肾功能恢复正常（17.39%）;2例患者肾功能延迟恢复（8.69%）,其中1例规律血透2周后肾功能恢复正常,另1例（最近1例）血透2月后肌酐维持在190μmmol/L并出院。在DCD肾移植后的随访过程中,随访时间为3个月~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条件下,有效解决肾移植面临肾源短缺的重要途径;良好的顶层设计及组织实施是心脏死亡器官捐献肾移植工作开展的有力保障。

Objective：To summarize the recent clinical experience of kidney transplantation using kidney donation after cardiac death（DCD）,and to investigate the efficacy of patients with end-stage renal disease（ESRD）receiving kidney transplant and the top-level design. Methods：The clinical data of ESRD patients receiving DCD kidney transplantation from October 2011 to September 2013 were retrospectively analyzed. Results ：All operations were successful. Renal function of 17 recipients（73. 91 %） and 4 recipients（17.39%）returned to normal on 5-7 d and 8-10 d respectively after the surgery;but the other 2 recipients experienced delayed recovery and accepted the 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 represent another method to safely expand the donor pool,and the good top-level design is a powerful guarantee to carry out the DCD.