未成年人DCD供者单只供肾移植86例的围手术期临床研究

Clinical study of single kidney transplantation from young pediatric donors after death： 86 cases report

目的分析未成年人公民逝世后器官捐献（DCD）单只供肾用于成人肾移植的围手术期处理，探讨其临床效果及安全性。方法回顾性分析2007年12月至2015年8月未成年人DCD单只供肾肾移植86例的临床资料。结果所有受者均顺利完成肾移植手术，手术成功率100%。术后3～21 d移植肾功能恢复正常，血肌酐水平为（131.88±44.20）μmol/L，恢复正常的平均时间为12.9 d。术后3～6个月内移植肾长度增长至9 cm左右，接近或达到成人肾脏大小水平。术后1年受者和移植肾总体存活率均为95.3%（82/86），术后2年受者和移植肾总体存活率均为93.7%（75/80）。受者术后发生急性排斥反应7例（8.14%），药物中毒10例（11.62%），移植肾功能延迟恢复（DGF）21例（24.44%），尿漏4例（4.65%），术后肺部感染7例（8.14%），其中2例（2.32%）受者术后出现严重肺部感染经抢救无效死亡。其余并发症采取相应治疗措施，2～4周后肾功能恢复正常。其余受者未发生并发症，均顺利恢复出院。结论经严格供受者选择后采用未成年人逝世后器官捐献单只供肾移植是安全可行。

Objective By analyzing the perioperative management in our hospital to explore the clinical effect and safety of single kidney transplantation from deceased juveniles’ donors.Methods We retrospectively analyze 86 cases of kidney transplantations from deceased juveniles＇ donors in our hospital from 2007 December to 2015 August.Results The success rate of the operations was 100%. The postoperative complications occurred as fellows： 7 cases of acute rejection （8.14%）; 10 cases of drug intoxication （11.62%）; 21 cases of DGF （24.44%）, 4 cases of leakage of urine （4.65%）, 7 cases of lung infection （8.14%）. Two cases （2.32%） died after the operation because of serious lung infection, and by corresponding treatment 47 cases recovered after 2-4 weeks. The creatinine level in 37 cases without any complications was 131.88±44.20 μmol/L during discharge.Conclusion With strict selection, the organ from a deceased juvenile donor is safe and practicable.