成人供肾双肾移植的临床疗效

Clinical effect of adult donor dual kidney transplantation

目的探讨成人供肾双肾移植(DKT)的临床疗效。方法回顾性分析2016年9月至2020年12月中南大学湘雅二医院收治的13例成人供肾DKT手术供受者的病例资料。13例供者年龄(53.5±12.4)岁, 体质量指数(BMI)(24.3±2.8)kg/m^(2), 3例有糖尿病史, 8例有高血压病史。13例中, 11例符合美国器官共享联合网络(UNOS)双肾移植标准, 6例符合Remuzzi评分双肾移植标准, 入院时和获取供肾前血清肌酐(SCr)分别为(132.9±54.1)μmol/L和(228.7±112.4)μmol/L。13例受者年龄(39.3±8.9)岁, BMI(20.2±2.4)kg/m^(2)。所有受者均接受ABO血型相合的肾移植, 2例双肾分别放置于双侧髂窝。12例移植肾开放血运后颜色鲜红、充盈迅速, 输尿管立即可见尿液流出, 1例双肾颜色偏暗, 血管搏动弱。记录受者围手术期移植肾功能恢复时间(从手术当天至SCr自然降至正常范围的时间)、移植肾功能延迟恢复(DGF)、急性排斥(AR)、输尿管并发症、手术切口并发症情况, 以及受者末次随访时的SCr、估算肾小球滤过率(eGFR)、尿蛋白和移植物结局。采用单因素logistic回归分析评估影响受者结局的危险因素。结果本组13例受者中, 10例出院时SCr降至正常范围内, 移植肾功能恢复时间(13.8±13.0)d;3例出院时SCr分别为300.0、149.0、152.5 μmol/L。4例发生DGF, 4例发生AR;并发症分别为输尿管狭窄1例, 尿瘘1例, 术后切口裂开1例, 分别予抗排斥、置入双J管、持续导尿维持膀胱空虚治疗和切口二次缝合, 出院前均治愈。术后中位随访28(15.5, 31.0)个月, 10例移植物功能良好, 2例出现移植肾功能不全, 1例移植肾失功。除移植肾失功患者外, 末次随访时SCr(144.2±101.3)μmol/L, eGFR(52.9±21.2)ml/min;4例末次随访尿蛋白阳性。单因素分析结果显示, 供者的年龄、BMI、糖尿病史、高血压病史、入院时SCr均与DGF和移植肾功能损伤无明显相关性(P>0.05)。结论成人供肾DKT的近期和中期效果良好。

Objective To explore the clinical efficacy of adult donor dual kidney transplantation.Methods Retrospective analysis of case data of 13 adult donor kidney dual kidney transplantation(DKT)performed in the The Second Xiangya Hospital of Central South University from September 2016 to December 2020.For 13 donors,the average age and BMI were(53.5±12.4)years and(24.3±2.8)kg/m^(2),respectively.Their mean Serum creatinine(SCr)at admission and before procurement was(132.9±54.1)and(228.7±112.4)μmol/L,respectively.3 of them had diabetes mellitus history,and 8 had hypertension history.11 met the United Network for Organ Sharing(UNOS)DKT criteria and 6 met Remuzzi score DKT criteria.For 13 recipients,the average age and BMI were(39.3±8.9)years and(20.2±2.4)kg/m^(2),respectively.All of them received ABO blood type-matched kidney transplants.2 of them had their grafts transplanted in the bilateral iliac.In 12 cases,the grafts filled rapidly and urinated immediately when opening blood flow.In I case,the grafts were dark in color and vascular showed weak pulsation after opening blood flow.The time to recovery of perioperative graft function(from the day of surgery to the natural reduction of SCr to the normal range 44-133μmol/L),the occurrence of delayed graft function(DGF),acute rejection(AR),ureteral and surgical incision complications,as well as the recipients'final follow-up SCr,eGFR,urinary protein,and grafts outcome were observed.Risk factors affecting outcomes were assessed by univariate logistic regression analysis.Results The SCr dropped to the normal range at discharge in 10 recipients,and the average recovery time was(13.8±13.0)days.In other 3 cases SCr at discharge were 300.0,149.0,152.5μmol/L.4 cases had DGF,4 had AR,1 experienced urinary fistula,and 1 experienced incisional dehiscence,which were treated with anti-rejection,J-tube implantation,continuous catheterization to maintain bladder void,secondary suturing,respectively.The follow-up time ranged from 4 to 54 months,with a median of 28(15.5,31.0)months.At the final follow-up time,10 cases had good graft function,2 suffered impaired kidney function,and 1 experienced graft failure.The average SCr and eGFR except for graft failure patient were(144.2±101.3)μmol/L and(52.9±21.2)ml/min,respectively.4 had positive urine protein.Univariate logistic regression analysis showed that donor age,BMI,history of diabetes mellitus and hypertension,and SCr were not significantly correlated with recipients'DGF and graft impairment(P>0.05),and due to the small sample size,multifactorial logistic regression analysis was not performed.Conclusion The short to medium-term effects of adult donor DKT coule be safe and feasible.