脑-心双死亡供肾与尸体供肾移植后疗效的比较

A comparison of outcomes between donation after brain-cardiac death and cadaver donors transplants

目的:比较脑-心双死亡器官捐赠(DBCD)供肾与传统尸体供肾移植的3年疗效差异。方法:回顾性分析四川省人民医院器官移植中心2009年11月至2012年1月的24例DBCD供肾移植受者及同期59例传统尸体肾移植受者,所有受者术后随访3年,比较两组受者肾移植术后围手术期并发症发生率,及3年内感染、排斥反应发生率,术后糖尿病、高血压、高脂血症发生率,术后收缩压、舒张压、胆固醇、三酰甘油、低密度脂蛋白、高密度脂蛋白,术后新发肿瘤发生率、钙调神经蛋白抑制剂(CNI)药物转化率;以及肾移植术后估算的肾小球滤过率(e GFR)情况,人/肾1年、2年、3年存活率等方面的差异。结果:DBCD肾移植组术后移植肾功能恢复延迟(DGF)和感染的发生率为33.3%和37.5%,而传统尸体肾移植组为11.9%和20.3%,差异有统计学意义(P<0.05)。术后7d和14d,DBCD肾移植组的e GFR低于传统尸体肾移植组(P<0.05),但术后1个月至3年,两组受者的e GFR差异无统计学意义。DBCD肾移植组术后1年、2年和3年的移植人/肾存活率分别为95.8%、87.5%、83.3%和95.8%、83.3%、75.0%,而传统尸体肾移植组分别为98.3%、94.9%、88.1%和96.6%、93.2%、78.0%,两组的差异无统计学意义。结论:DBCD肾移植术后发生DGF及围手术期感染的发生率较高,但其长期疗效与传统尸体肾移植相当。

Objective： To compare outcomes between donation after brain-cardiac death（ DBCD） and traditional deceased donor transplants within 3 years after transplant. Methodology： This was a single-center retrospective study of24 cases of DBCD kidney transplantation performed in our hospital between November 2009 and January 2012,compared with 59 cases of traditional deceased kidney transplantation during the same period. The complications and effects within 3years after transplant were compared between the two groups. Results： The incidence of delayed graft function（ DGF）（ 33. 3% vs 11. 9%,P〈0. 05） and incidence of infection（ 37. 5% vs 20. 3%,P〈0. 05） in DBCD Group were significantly higher than those in traditional deceased donor Group. The e GFR levels of DBCD group were significantly lower than those of traditional deceased donor group on the postoperative day 7 and 14（ P〈0. 05）,but there were no differences in the e GFR levels 1 month,1 year,2 year and 3 year after transplantation between the two groups（ P〈0. 05）. The1-year,2-year and 3-year recipient / graft survival rate were 95. 8%,87. 5%,83. 3% and 95. 8%,83. 3%,75. 0% in DBCD group,and those were 98. 3%,94. 9%,88. 1% and 96. 6%,93. 2%,78. 0% in traditional deceased donor group,respectively. There was no differences between the two groups. Conclusion： The long-term outcome of DBCD donors is similar to traditional deceased donors,despite of higher DGF and infection rate within preoperative period.