夫妻间活体供肾移植临床疗效分析

The clinical effect of living kidney transplantation between spouses

目的:总结分析夫妻间肾移植术后的临床效果,探讨其在当今社会的意义。方法:回顾性分析吉林大学第一医院2009年10月至2018年12月实施的夫妻间肾移植(夫妻组)的临床资料,并与同期完成的父母与子女间(父母组)以及直系兄弟姐妹间(兄妹组)肾移植进行比较,分析三组活体肾移植受者的移植效果。结果:夫妻间肾移植3年及5年移植肾存活率为94.1%及83.7%,与另外两组活体肾移植相比差异均无统计学意义(P=0.260);在术后3年内各时间点血肌酐比较上,夫妻间肾移植与其他类型活体肾移植相比差异亦无统计学意义;在术后3年及5年的血肌酐比较上,夫妻间肾移植与直系兄妹间肾移植比较差异无统计学意义,但比父母子女间肾移植的血肌酐值更低(P=0.014、0.038);夫妻间肾移植术后1年排斥反应发生率为25%,显著高于其他类型亲属肾移植(P=0.029);供者年龄,受者性别,供、受者体型匹配及术后1年内AR的发生与活体肾移植术后1年血肌酐具有独立相关性(相关系数分别为:0.048、-26.03、-15.95及10.23;P=0.003、P<0.001、P<0.021及P<0.013)。结论:夫妻间肾移植相比于其他类型亲属肾移植具有同样可靠的临床效果,可以成为供肾来源的有效途径,值得大力推广,但相比其他类型活体肾移植应更加警惕排斥反应的发生以获得更佳的肾移植效果。

Objective To investigate the clinical effect of spousal kidney transplantation,and to explore the significance in today's society.Methods We retrospectively collected the relevant clinical data from the transplantation department of the first hospital of jilin university,from October 2009 to December 2018.Receptors who accepted spousal,parental and compatriot donor kidney is respectively obtained.Then the postoperative efficacy of the three groups were compared.Results The graft survival rates of spousal kidney transplantation were 94.1%at 3 years and 83.7%at 5 years,which were not significantly different from other types of living kidney transplantation(P=0.260).There was no significant difference in creatinine at each time point within 3 years after operation between three groups.At 3 years and 5 years after operation,there was no significant difference in creatinine between spouse group and sibling group.But the creatinine of spouse group was lower compared with parent group(P=0.014,0.038).The incidence of rejection within 1 years after spousal renal transplantation was 25%,which was significantly higher than parent group and sibling group(P=0.029).Age of donor,gender of recipient,D/R BMI and incidence of AR or not in recipient were independent predictors for 1-year creatinine in living kidney transplantation(correlation coefficient:0.048、-26.03、-15.95、10.23;P=0.003、<0.001、0.021、0.013).Conclusions Spousal kidney transplantation has same clinical efficacy compared with other types of living kidney transplantation,which can greatly improve the donor kidney resource.So it worth being further promotion,but compared with other types of living kidney transplantation,we should be more alert to the incidence of rejection reaction,so as to obtain better curative effect.