公民逝世后捐献时代减激素方案在糖尿病肾病肾移植中的应用及效果

Application and efficacy of reduced cyclosporine-based regimen of kidney transplantation in patients with diabetic kidney disease from deceased donor

目的:探讨公民逝世后捐献(DD)供肾糖尿病肾病(DKD)肾移植的免疫抑制方案。方法:分析我中心2012年3月~2016年12月的19例DD供肾DKD肾移植术后患者,采用环孢素为主的减激素三联方案;将来源于同一供体的19例非糖尿病受者作为非DKD组,记录DKD患者的血糖及相关指标,比较两组人/肾生存率、急性排斥(AR)、移植肾功能延迟恢复(DGF)、感染及其他不良事件发生情况。结果:38例受者随访时间(21.4±17.5)个月,早期移植肾脏恢复情况好,DKD组患者术后第1年人/肾生存率为93.8%/88.8%,第3年为93.8%/88.8%;非DKD组患者术后第1年和第3年人/肾生存率均为100%/100%。DKD组与非DKD组AR发生率分别为10.5%(2/19)与5.3%(1/19);DKD组发生DGF 2例,非DKD组1例;DKD组发生感染6例,非DKD组4例;二者差异均无统计学意义(P>0.05)。DKD组发生移植肾破裂1例,重症肺炎1例。术后2~39个月穿刺病理显示DKD组患者移植肾脏均未出现糖尿病相关改变。结论:DKD患者接受减激素为中心的免疫抑制方案疗效及安全性均可,值得进一步在DKD患者中应用。

Objective：To investigate the immunosuppressive regimen of kidney transplantation in patients with diabetic kidney disease from deceased donor（DD）.Method：From March 2012 to December 2016,19 patients with diabetic kidney disease（DKD）were treated with reduced cyclosporine-based regimen after kidney transplantation,other 19 patients without DKD from the same donor were the non-DKD group.We observed and recorded fasting blood-glucose（FBG）and other indexes of DKD patients,patient/graft survival rate,acute rejection（AR）,delayed graft function（DGF）,infection and other adverse events were compared between the two groups.Result：The follow-up period of 38 patients was（21.4±17.5）months,one-year patient/graft survival rate was 93.8%/88.8% and three-year patient/graft survival rate was 93.8%/88.8%in the DKD group,and the non-DKD group was 100%/100% with one-year and three-year patient/graft survival rate.The incidence rate of AR in DKD group and non-DKD group was 10.5%（2/19）and 5.3%（1/19）respectively.There were 2 cases of DGF in DKD group and 1 case in non-DKD group.There were 6 cases of infection in DKD group and 4 cases in non-DKD group.The difference was not statistically significant（P〉0.05）.One case of graft rupture occurred in DKD group,as well as a severe pneumonia.Postoperative puncture pathology between 2-39 months showed no diabetic-related changes in the transplanted kidneys in patients with DKD.Conclusion：The efficacy and safety of immunodeficiency regimen in patients with DKD is acceptable,and it should be further applied in DKD patients.