不同亲属关系活体供肾肾移植长期疗效分析

Long-term curative effect of different relatives living donor kidney transplant

目的观察亲属活体供肾来源的肾移植长期疗效,对比分析不同亲属关系供肾的临床效果。方法回顾性分析郑州人民医院2008年4月至2014年2月完成的237例亲属活体供肾移植的临床资料,按供肾来源分为母供→子组（A组,82例）,父供→子组（B组,34例）,母供→女儿组（C组,51例）,父供→女儿组（D组,26例）,兄弟姐妹间男供→女组（E组,19例）,兄弟姐妹间女供→男组（F组,25例）。观察记录各组术后各时间点血肌酐水平、蛋白尿发生情况、感染和排斥反应发生率等。结果随访2 a,无供受者死亡或移植物丢失,人/肾存活率100%;围术期均无感染发生,肺部感染多发生在术后2~4个月,排斥反应也多发生在肺部感染、腹泻后,各组肺部感染、排斥反应、腹泻、骨髓抑制及肝毒性等并发症比较差异均无统计学意义（P〉0.05）。术后1 a A组受者血肌酐水平升高,均高于其他组受者（P〈0.05）,但D组受者血肌酐水平术后持续低于其他组（P〈0.05）;术后A组中有6例患者持续存在蛋白尿,蛋白尿发生率高于其他组（P〈0.05）。结论亲属活体供肾移植具有较好疗效,母亲供肾给儿子移植后长期疗效相对较差,父亲供肾给女儿移植疗效相对较佳。

Objective To observe the long-term effect of relatives living donor kidney sources renal transplantation and compare the clinical effect of different kinship donor kidney in kidney transplantation patients. Methods The clinical data of237 cases relatives living donor renal transplantation in the People＇s Hospital of Zhengzhou from April 2008 to February 2014 were analyzed retrospectively. According to the renal source,237 cases were divided into the mother→son group（ group A,82cases）,father→son group（ group B,34 cases）,mother→daughter group（ group C,51 cases）,father→daughter group（ group D,26 cases）,brothers and sisters male → female group（ group E,19 cases）,brothers and sisters for female → male group（ group F,25 cases）. The time of serum creatinine returned to normal after operation,serum creatinine levels at each time point,condition of urine protein,incidence of infection and rejection of patients in each group were observed and recorded. Results In 2 years follow-up,no donor-recipient death or graft loss,and the patients / renal survival rate was 100%. No infection occurred in perioperative; the pulmonary infection occurred in 2- 4 months postoperative; rejection occurred after lung infections and diarrhea; there was no statistic difference of lung infection,rejection,diarrhea,bone marrow suppression and hepatic toxicity of patients in each group（ P〉0. 05）. The serum creatinine levels of recipients in group A were significantly higher than those in other groups at one year after operation（ P〈0. 05）; and the serum creatinine levels of recipients in group D were continuous lower than those in other groups（ P〈0. 05）. After operation,6 patients with persistent proteinuria in group A; and the incidence of proteinuria in group A was higher than that in other groups（ P〈0. 05）. Conclusion The relatives living donor kidney sources renal transplantation has good clinical effect; and father → daughter group has better long clinical effect,but mother→son group has bad clinical effect.