不同来源供体及后腹腔镜活体供肾移植的临床疗效分析

Clinical efficacy analysis of donor kidney transplantation from different sources and retroperitoneal laparoscopic living donor kidney transplantation

目的探讨亲属活体捐献(living donor,LD)与公民逝世后器官捐献(deceased donor,DD)肾移植的短期临床效果及影响因素,并研究不同活体供肾获取方式对短期移植肾功能的影响。方法回顾性分析2019年1月至2021年8月在宁波市鄞州第二医院接受同种异体肾移植术的80例受者,其中LD肾移植16例,DD肾移植64例;另选取2006年10月至2010年10月在宁波市鄞州第二医院行LD肾移植术的29例受者,其中活体肾移植根据供肾手术方式不同,分为3D后腹腔镜活体供肾切取术和开放活体供肾切取术,其中后腹腔镜组16例,开放手术组13例。观察患者的性别、年龄、术前体质量指数(body mass index,BMI)、透析方式、透析时间、术前及术后(3d、7d、1个月、3个月、6个月、12个月)血肌酐、冷缺血时间(cold ischemia time,CIT)、热缺血时间(warm ischemia time,WIT)、术后住院时间、移植肾恢复及存活情况。结果LD组受者年龄显著小于DD组(P<0.05),透析时间、术后住院时间、CIT、WIT均显著短于DD组(P<0.05),术后3d、7d的血肌酐水平均显著低于DD组(P<0.05)。在短期预后方面,LD组受者的移植肾功能延迟恢复(delayed graft function,DGF)发生率显著低于DD组(P=0.033)。活体肾移植中,后腹腔镜组受者的术后住院时间显著短于开放手术组(P=0.012),出院时血肌酐水平显著低于开放手术组(P=0.008),但两组受者的预后未见明显差异。结论目前DD是供体的主要来源,但短期临床疗效不及LD,应综合评估,提高DD供体的有效利用率。

Objective To explore the short-term clinical effects and influencing factors of living donor(LD)and deceased donor(DD)kidney transplantation,and to study the effects of different ways of obtaining living donor kidney on short-term renal function.Methods A total of 80 recipients who received allogeneic kidney transplantation in Ningbo Yinzhou Second Hospital from January 2019 to August 2021 were retrospectively analyzed,included 16 cases of LD kidney transplantation and 64 cases of DD kidney transplantation.In addition,29 recipients who underwent LD kidney transplantation in Ningbo Yinzhou Second Hospital from October 2006 to October 2010 were selected.Among them,LD kidney transplantation was divided into 3D retroperitoneal laparoscopic LD nephrectomy and open LD nephrectomy according to the different methods of donor kidney surgery,included 16 cases in retroperitoneal laparoscopic group and 13 cases in open surgery group.The gender,age,preoperative body mass index(BMI),dialysis method,dialysis time,and serum creatinine levels of recipients before and after surgery at 3d,7d,1month,3months,6months,and 12months,cold ischemic time(CIT),warm ischemic time(WIT),postoperative hospitalization time,recovery and survival of transplanted kidneys were compared.Results The age of recipients in LD group was significantly younger than that in DD group(P<0.05),and the dialysis time,postoperative hospitalization time,CIT,and WIT were significantly shorter than those in DD group(P<0.05).The blood creatinine levels were significantly lower than those in DD group on the 3d and 7d postoperative(P<0.05).In terms of short-term prognosis,the incidence of delayed graft function(DGF)in LD group was significantly lower than that in DD group(P=0.033).Among LD kidney transplant recipients,the postoperative hospitalization time in retroperitoneal laparoscopic group was significantly shorter than that in open surgery group(P=0.012),and the blood creatinine level at discharge was significantly lower than that in open surgery group(P=0.008),but there was no significant difference in prognosis.Conclusion At present,DD is the main source of donors,but the short-term clinical effect is not as good as that of LD.It should be comprehensively evaluated to improve the effective utilization rate of DD.