67例肾移植后移植肾功能恢复的多因素分析

Factors and prognosis analysis of graft renal function recovery after DCD donor renal transplantation

目的分析影响器官捐献供肾移植后移植物功能恢复的因素。方法对山西省第二人民医院2012年8月至2015年9月间67例器官捐献供肾移植的资料进行回顾性分析，依据受者术后肾功能是否稳定分为肾功能稳定组（51例），移植肾功能恢复延迟组（16例）。分析两组受者年龄、性别、透析类型及时间，供者脑死亡原因、术前应用去甲肾上腺素情况、供肾热缺血时间等临床资料。分析术后移植物功能恢复相关影响因素，采用Logistic回归分析术后移植物功能延迟恢复危险因素，统计比较两组受者术后3个月、6个月、1年和18个月的存活率。结果供者脑死亡原因、供肾热缺血时间、术前透析类型及时间、术前是否应用去甲肾上腺素、婴幼儿供者均为影响术后移植物功能恢复的相关因素（P〈0.05）；由Logistic回归分析可知，脑出血死亡供者、热缺血时间较长、术前血液透析时间长、术前应用去甲肾上腺素均为术后发生DGF的危险因素（P〈0.05）；肾功能稳定组术后3个月、6个月、1年和18个月的受者存活率均高于移植肾功能恢复延迟组（P〈0.05）。结论脑出血死亡供者、热缺血时间较长、术前血液透析时间长、术前应用去甲肾上腺素均为术后移植物功能延迟恢复独立危险因素，且移植物功能延迟恢复患者预后情况较差，临床中应极力消除或减少此类危险因素，有效预防术后移植物功能延迟恢复，进而有助于改善患者预后。

ObjectiveTo analyze the factors and prognosis of graft recovery after donation after citizens death （DCD） donor renal transplantation.MethodsA retrospective analysis of 67 cases of DCD renal transplantation from August 2012 to September 2015 in our hospital was carried out. According to the stability of renal function after operation, the patients were divided into group A （51 cases） with stable renal function, and 16 cases in group B （delayed graft function after operation）. The clinical data of two groups including age, gender, cause of death, warm ischemia time, type of dialysis, and application of norepinephrine before operation were collected and analyzed. The related factors of graft function recovery were analyzed. Logistic regression analysis was used to analyze the risk factors of graft functional recovery after operation. The 3-month, 6-month, 1-year and 18-month survival rate after operation in the two groups was compared.ResultsThe causes of death, the time of ischemia, the type of dialysis before operation, the application of norepinephrine before operation, infants and young donors were related factors of graft function recovery （P〈0.05）. Logistic regression analysis showed that cerebral hemorrhage death donor, the long thermal ischemia time, the preoperative hemodialysis and the application of norepinephrine before operation were the risk factors of delayed graft function recovery （P〈0.05）. The 3-month, 6-month, 1-year and 18-month survival rate after operation in group A was higher than that in group B, with the difference being statistically significant （P〈0.05）.ConclusionCerebral hemorrhage death donor, the long thermal ischemia time, the preoperative hemodialysis and the application of norepinephrine before operation were the independent risk factors of delayed graft function recovery. And the prognosis of patients with delayed graft function was poor. Clinical risk should be eliminated or reduced in clinical practice, which can effectively prevent the delayed graft function and further improve the prognosis of the patients.