扩大标准肾移植术后临床效果分析和器官维护策略探讨

Clinical effect analysis and organ maintenance strategy investigation for expanded standard DCD renal transplantation

目的分析与比较扩大标准供体(extend criteria donors,ECD)和标准供体(standard criteria donors,SCD)肾移植术后临床效果,探讨ECD的器官维护策略。方法回顾性地分析2014年2月至2022年2月在空军军医大学第一附属医院接受尸体供肾移植且在该中心和西安市人民医院泌尿肾脏病院规律随访的90例受体临床资料,分为ECD组31例和SCD组59例。所有供肾均常规采用单纯低温静置保存。所有受体均应用抗体诱导,常规采用三联免疫抑制治疗(吗替麦考酚酯胶囊/麦考酚钠肠溶片、他克莫司/环孢素、甲泼尼龙)。比较两组受体在肾移植术后1个月、3个月、6个月、1年、2年、3年、5年的血肌酐(serum creatinine,Scr)、并发症的发生情况及人/肾存活率,并进行统计学分析。结果ECD组术后1个月、3个月、6个月、1年、2年、3年、5年的Scr显著高于SCD组(P<0.05)。ECD组AR发生率为12.9%(4/31),SCD组为18.6%(11/59),ECD组和SCD组DGF发生率分别为22.6%(7/31)和16.9%(10/59),肺部感染的发生率分别为12.9%(4/31)和6.8%(4/59),其他感染发生率分别为25.8%(8/31)和15.3%(9/59),持续性蛋白尿分别为22.6%(7/31)和15.3%(9/59),其他并发症的发生率分别为19.4%(6/31)和10.2%(6/59),均无显著性差异(P>0.05)。ECD组1年、3年、5年人/肾存活率分别为93.5/90.3、90.3/83.9、87.1/77.4,SCD组分别为91.5/93.2、89.8/91.5、88.1/89.8,两组差异均无统计学意义(P>0.05)。结论ECD供体肾移植与SCD相比,能够获得一定的临床效果,可以扩大供肾来源,但在长期临床效果尤其是肾功能仍略差于SCD,需要进一步加强ECD待获取器官的有效功能保护和围术期管理。

Objective To analyze and compare the clinical efficacy of renal transplantation between extend criteria donors(ECD)and standard criteria donors(SCD)of the donation after citizen death.Methods The clinical data of 90 recipients who received cadaveric kidney transplantation in the First Affiliated Hospital of the Air Force Military Medical University from February 2014 to February 2022 and were regularly followed up in the center and the Urology and Kidney Hospital of Xi'an People's Hospital were retrospectively analyzed.The recipients were divided into 31 ECD patients and 59 SCD patients.All donor kidneys were routinely preserved by simple hypothermia conditions.All recipients were induced by antibodies,and were routinely treated with triple immunosuppressive therapy(mycophenolate mofetil capsule/mycophenolate sodium enteric-coated tablets,tacrolimus/cyclosporine,methylprednisolone).The serum creatinine(Scr),complications and recipient/renal survival rate of the two groups of recipients at 1 month,3 months,6 months,1 year,2 years,3 years and 5 years after renal transplantation were compared and statistically analyzed.Results The Scr level in ECD group at 1 month,3 months,6 months,1 year,2 years,3 years and5 years after operation was significantly higher than that in SCD group(P<0.05).In ECD group and SCD group,the incidence of AR was 12.9%(4/31)and 18.6%(11/59),the incidence of DGF was 22.6%(7/31)and 16.9%(10/59),the incidence of lung infection was 12.9%(4/31)and 6.8%(4/59),the incidence of other infections was 25.8%(8/31)and 15.3%(9/59),the incidence of persistent proteinuria was 22.6%(7/31)and 15.3(9/59),and the incidence of other complications was 19.4%(6/31)and 10.2%(6/59).There was no significant difference between ECD group and SCD group(P>0.05).In ECD group,the annual recipient/renal survival rate in 1,3 and 5 years was 93.5/90.3,90.3/83.9,87.1/77.4,respectively,while in SCD group,it was 91.5/93.2,89.8/91.5,88.1/89.8,respectively.There was no significant difference between the two groups(P>0.05).Conclusion Compared with SCD,ECD donor kidney transplantation can achieve a certain clinical effect and expand the source of donor kidney,but the long-term clinical effect,especially the renal function,is still slightly worse than SCD.It is necessary to further strengthen the effective function protection and perioperative management of organs to be obtained from ECD.