婴幼儿双供肾成人肾移植临床效果研究

Clinical efficacy of dual-kidney transplantation from infant donors to adult recipients

目的探讨婴幼儿双供肾成人肾移植的临床疗效。方法回顾性分析2012年12月至2020年11月中山大学附属第一医院25例婴幼儿双供肾成人肾移植的供、受者临床资料。计算术后1、3、5年受者和移植肾存活率,观察受者术后肾功能恢复情况及术后不良事件发生情况。结果25例婴幼儿双供肾成人肾移植受者的第1、3、5年存活率均为95.8%,移植肾及死亡删失移植肾的第1、3、5年存活率均为87.2%。1例受者因急性下壁心肌梗死死亡,3例受者分别因移植肾血管血栓形成或输尿管狭窄、尿漏导致移植肾功能丧失。除受者移植肾功能丧失及死亡外,术后1、2、3年估算肾小球滤过率分别为:(99.35±21.78)ml/(min·1.73 m2)、(103.11±29.20)ml/(min·1.73 m2)、(114.99±28.55)ml/(min·1.73 m2)。结论婴幼儿器官捐献供肾的双肾成人肾移植的总体移植效果较满意,做好供、受者匹配,规范供肾获取及手术流程,加强围术期管理可提高成人受者长期疗效,可作为扩大供者来源的重要途径。

Objective To explore the clinical efficacy of dual-kidney transplantation from infant donors to adult recipients.Methods From December 2012 to November 2020 in Organ Transplant Center First Affiliated Hospital Sun Yat-sen University,rertrospective reviews were conducted for clinical data of 25 pairs of infant donors and adult recipients.The survival rates were calculated for both recipients and transplanted kidneys at Year 1/3/5 post-transplantation.And the postoperative recovery status and the postoperative incidence of adverse events of recipients were observed.Results The survival rates of recipients were all 95.8%at Year 1/3/5 and those of transplanted kidney and dealth-cancelling transplanted kidney all 87.2%.One case died due to acute inferior-wall cardiac infarction while three others lost renal functions for vascular thrombosis,ureteral stenosis and urinary fistula.Except for loss of renal function and death,the postoperative estimated golmerular fitration rate was(99.35±21.78),(103.11±29.20)and(114.99±28.55)ml/(min·1.73 m2)at Year 1/2/3 respectively.Conclusions Selecting proper recipients,standardizing donor acquisition and surgical procedures and strengthening perioperative managements may expand the donor pool.The overall outcomes are excellent for adult recipients with dual-kidney transplantation from donations after infants'death.