亲属活体肾移植受者术后并发症的诊治分析

Diagnosis and treatment of postoperative complications of living donor kidney transplant recipients

目的总结235例亲属活体肾移植受者术后并发症的发生情况,提高肾移植术后并发症的诊治效果。方法回顾性分析本院2012年1月—2017年6月收治的235例亲属活体受者的临床资料,对其术后恢复情况、并发症进行分析。结果 235例受者出院时血肌酐为100.1μmol/L,其中1例因呼吸衰竭死亡,4例移植肾失功,余230例受者近期复查血肌酐为111.8μmol/L。随访6～59个月,并发症包括急性排斥反应、肺部感染、尿路感染、切口感染、移植肾动脉感染、带状疱疹、尿瘘、移植肾输尿管梗阻、移植肾功能延迟恢复、移植肾动脉狭窄、移植肾失功、免疫抑制剂中毒、药物性腹泻、骨髓抑制、肝功能不全、移植后糖尿病等。受者和移植肾的1年生存率分别为99.8%、98.7%。术前使用抗胸腺细胞球蛋白(antithymocyte,ATG)或巴利昔单抗诱导可明显降低术后排斥反应的发生(P <0.05)。结论术前充分评估、术中精细操作、术后严密随访和及时治疗术后并发症,可有效提高移植肾的生存率。

Objective To summary the incidence of postoperative complications in 235 living donor kidney transplantation recipients,and improve diagnosis and treatment of complications after renal transplantation.Methods A retrospective analysis of the clinical data of 235 living donor kidney transplantation recipients admitted from January 2012 to June 2017 in the First Hospital of JiLin University,to analyze its postoperative recovery and complications.Results The mean serum creatinine was 100.1μmol/L when 235 recipients leaving hospital,with 1 case died of respiratory failure and 4 cases of renal allograft failure,the recent reexamination of serum creatinine was 111.8μmol/L in the remaining 230 patients.Following up for 6~59 months,complications included acute rejection,pulmonary infection,urinary tract infection,wound infection,renal artery infection,herpes zoster,urinary fistula and ureter obstruction after renal transplantation,delayed graft function,renal artery stenosis,renal allograft failure,immunosuppressant drug poisoning,diarrhea,myelosuppression,hepatic insufficiency,transplantation diabetes.The 1 year survival rates of the recipients and the transplanted kidneys were 99.8%and 98.7%,respectively.Preoperative use of antithymocyte(ATG)or bariximab could significantly reduce the incidence of postoperative rejection(P﹤0.05).Conclusion The survival rates of the transplanted kidney could be improved effectively in some methods,such as preoperative comprehensive assessment,intraoperative detailed operation,regular follow-up and timely intervention of complications after operation.