扩大标准公民逝世后器官捐献肾移植术后一年内临床效果分析

Clinical analysis within one year after kidney transplantation from extended criteria donors of donation after citizen′s death

目的观察并比较扩大标准供者(ECD)和标准供者(SCD)供肾移植受者术后1年内临床效果。方法回顾性分析2014年3月至2017年3月空军军医大学西京医院接受公民逝世后器官捐献90例肾移植受者临床资料,按供肾来源分为ECD组(31例)和SCD组(59例)。所有受者均应用免疫诱导及三联免疫抑制方案治疗(吗替麦考酚酯或麦考酚钠肠溶片+他克莫司或环孢素+甲泼尼龙)。采用t检验或Mann-Whitney U检验比较两组受者肾移植术后1年内血清肌酐(Scr)水平,采用χ2检验和Fisher确切概率法比较两组受者性别比例、受者/移植肾存活率及急性排斥反应(AR)、移植肾功能延迟恢复(DGF)和肺部感染等并发症发生率。P<0.05为差异有统计学意义。结果ECD组和SCD组肾移植受者术后Scr水平逐步下降。术后1个月内(术后1、3、7、14和21 d)两组受者Scr水平差异均无统计学意义(t=0.076、0.905、0.670、0.893和0.048,P均>0.05);术后1~12个月,除术后9个月两组受者Scr水平差异无统计学意义(t=1.727,P>0.05),其余各时间点ECD组受者Scr水平均高于SCD组,差异均有统计学意义(P均<0.05)。两组受者术后1年受者/移植肾存活率分别为93.1%/80.6%和91.5/84.7%,差异均无统计学意义(P=0.734;χ^2=0.246,P>0.05)。ECD组和SCD组AR发生率分别为12.9%(4/31)和18.6%(11/59),DGF发生率分别为22.6%(7/31)和22.0%(13/59),肺部感染发生率分别为25.8%(8/31)和11.9%(7/59),其他并发症发生率分别为41.9%(13/31)和28.8%(17/59),差异均无统计学意义(P均>0.05)。结论与SCD相比,ECD供肾移植仍可获得相当的临床效果。在目前供器官来源严重缺乏的情况下,ECD的合理选择可以扩大供肾来源。

Objective To compare the clinical efficacy within 1 year after kidney transplantation between extend criteria donors(ECD)and standard criteria donors(SCD)of donation after citizen′s death.Methods Clinical data of 90 recipients undergoing kidney transplantation from donation after citizen′s death in Xijing Hospital,Air Force Military Medical University during March 2014 and March 2017 were retrospectively analyzed.According to the types of donors,recipients were divided into the ECD group(n=31)and SCD group(n=59).All recipients were treated with immunoinduction therapy and triple immunosuppressive regimen(mycophenolate mofetil or mycophenolate sodium enteric-coated tablets+tacrolimus or cyclosporine+methylprednisolone).T test or Mann-Whitney U test were used to compare the serum creatinine(Scr)levels within 1 year after kidney transplantation between the two groups.The sex ratio,survival rate of recipients/transplant kidneys and incidence of acute rejection(AR),delayed graft function(DGF),pulmonary infection and other complications between the two groups were compared byχ2 test and Fisher′s exact probability method.The difference was statistically significant when P<0.05.Results Scr levels of renal transplant recipients in ECD group and SCD group decreased gradually after transplantation.No statistical significance was observed in the levels of Scr within 1 months after transplantation(1,3,7,14 and 21 days after transplantation)between the two groups(t=0.076,0.905,0.670,0.893 and 0.048,P all>0.05).Except 9 months after transplantation,the levels of Scr within 1 year after kidney transplantation in ECD group was all higher than that in SCD group(P all<0.05).The 1 year survival rates of the recipients and transplant kidneys in two groups were 93.1%/80.6%and 91.5/84.7%,respectively,no statistical significance were observed(P=0.734;χ^2=0.246,P>0.05).The incidence of AR,DGF,pulmonary infection and other complications in ECD group and SCD group were 12.9%(4/31)and 18.6%(11/59),22.6%(7/31)and 22.0%(13/59),25.8%(8/31)and 11.9%(7/59),41.9%(13/31)and 28.8%(17/59),respectively,no significance was found(P all>0.05).Conclusions ECD kidney transplantation can achieve equivalent clinical efficacy compared with the SCD.The application of kidney grafts from ECD can enlarge the supply of donor kidneys under the current situation in which the donor organs was severely insufficient.