间充质干细胞改善器官捐献供肾移植早期临床效果的研究

Mesenchymal stem cells improve transplant renal function from donation after citizens death： a shortterm dinical trials

目的探讨间充质干细胞（MSC）在改善器官捐献来源供肾肾移植功能恢复中的效果及安全性。方法回顾性分析2011年7月至2016年12月在南京军区福州总医院完成的97例器官捐献供肾肾移植资料，其中肾移植联合MSC治疗组50例（治疗组），未行MSC治疗组47例（对照组）。治疗组受者分别于肾移植术中血管开放前、术后1周、术后2周、术后3周静脉输注约1×106/kg体重的脐带来源MSC悬液50 ml。分析评价2组受者术后3个月内肾功能恢复情况、移植肾功能恢复延迟（DGF）发生率及持续时间、肺部感染发生率、急性排斥反应（AR）发生率，以及外科并发症等情况。结果治疗组DGF发生率为16.0%，持续时间（14.42±3.95）d，对照组发生率为27.7%，持续时间为（17.85±6.25）d，两组间的差异有统计学意义。治疗组AR发生率为12.0%，对照组为21.3%，差异有统计学意义；治疗组肺部感染发生率为10.0%，对照组为12.7%，差异无统计学意义。术后1个月与3个月时，对照组估算肾小球滤过率（eGFR）均低于治疗组（P〈0.05）；而术后1周时两组间的差异无统计学意义。两组间外科并发症发生率的差异无统计学意义。结论MSC治疗组患者术后DGF发生率更低、持续时间更短，AR发生率也更低，显示肾功能恢复趋势要明显优于对照组。但是两组间肺部感染以及外科并发症发生率并无明显差异。

ObjectiveTo investigate the efficacy and safety of mesenchymalstem cells （MSCs） in improving the renal transplantation functional recovery of donation after citizens death （DCD） derived renal donors.MethodsA retrospective analysis of 97 cases of DCD renal transplantation was performed in our center from July 2011 to December 2016. Among them, 50 cases were treated with MSCs （the treatment group） and 47 cases without MSCs （the control group）. In the treatment group, the umbilical cord stem cell suspension （50 mL, approximately 1 106/kg weight） was infused before vascular patency and 1 week, 2 weeks, and 3 weeks after renal transplantation. Postoperative renal function within 3 months of recovery, delayed graft function （DGF） incidence and duration, the incidence of pulmonary infection, acute rejection and surgical complications were analyzed.ResultsThe incidence rate of DGF and duration in the treatment group were 16.0% and （14.42±3.95） days, and those in the control group were 27.7% and （17.85±6.25） days respectively, and there were statistically significant difference. The incidence of acute rejection in the treatment group and the control group was 12.0 and 21.3% respectively with the difference being statistically significant. The incidence rate of pulmonary infection in the treatment group and control group was 10% and 12.7% respectively with the different being not statistically significant. Comparison of eGFR at 1st, 1st month and 3rd month after operation showed that the eGFR in the control group was statistically significantly lower than that in the treatment group at 1st and 3rd month, but there was no significant difference in eGFR at 1st week between the two groups. There was no significant difference in the surgical complications between the two groups.ConclusionIn the treatment group, the incidence rate of DGF was lower, and DGF duration was shorter than in the control group. The acute rejection rate in the control group increased significantly, but there was no significant difference in pulmonary infection and surgical complications between two groups. The recovery trend of renal function in the treatment group was better than that in the control group.