55岁以上活体亲属供肾移植相关问题探讨

Over 55 years-old live-related donor kidney transplants: a report of 12 cases

目的 探讨 5 5岁以上活体亲属供肾移植适应证、围手术期处理方法及预后。 方法1999年 10月至 2 0 0 2年 4月共实施活体亲属肾移植 15例 ,其中 5 5岁以上供体 12例。年龄 5 5～ 73岁 ,平均 6 2 7岁。父亲供肾 5例 ,母亲 6例 ,祖母 1例。供体纳入标准 :一般健康状况良好 ,营养及心理状态好 ,完全志愿及家庭无争议。无高血压和糖尿病 ,心肺肝等重要脏器功能健全。肾功能评价 :肌酐(Creatinine ,Cre) <133μmol/L ,肌酐清除率 (Creatinineclearance ,Ccr)和肾小球滤过率 (Glomerularfiltrationrate ,GFR) >80ml/min ,彩超 ,肾动脉造影等无异常。 12例受体均为尿毒症患者 ,年龄 14～ 4 6岁 ,平均 33岁。供体中 8例插管全麻 ,4例连续硬膜外麻醉。 10例取左肾 ,2例右肾。热缺血 70～ 170s ,平均 92s。冷缺血 6 0～ 12 0min ,平均 84min。移植方式同尸肾。随访 12～ 4 2个月 ,平均 2 0 8个月。 结果 12例供体均平稳度过围手术期 ,平均拆线时间 11d ,平均住院时间 11d。未发生任何手术并发症 ,均已恢复术前生活状态。复查肾功能 ,肌酐升高 12～ 34μmol/L ,平均 2 2 μmol/L。 12例受体中 1例因肝功能衰竭于移植后 6个月死亡。 1例于术后第 2 8天死于肺部感染。 1例移植肾功能延迟 ,经透析 12次肾功恢复。

Objective To evaluate the risk factors of the over 55-year-old donor and the safety and efficacy of the donor, and the recipient with the immediate and long-term of the kidney. Methods The living-related donor kidney transplantation in 15 cases was performed in our unit from October 1999 to April 2002.Of these, 12 donors were over 55 with age ranging from 55 to 73 years-old and mean age of 62, 75 years. 5 donors were male and 7 were female. Father in 5 cases and 6 and 1 were mother and grandmother, respectively. The donors were evaluated depending on general state of health, hypertension, diabate and important organa in condition; and renal function by creatinine (Cre), cretinine clearance (Ccr), Glomerular filtration rate (GFR), B ultrasound and renal arteriograph prior to operation. The all receipients with ages ranging from 14 to 46 years with end-stage renal diseases (ESRD) from and their mean age was 32.9 years.The donor′left nephrectomy was performed in 10 cases and right nephrectomy in 2.Warm-ischemia time was from 70 s to 170s (mean time,92 s). Cold-ischemia time was from 60 minntes to 120 minntes and mean 84 minntes. The follow-up is from 12 to 42 months and mean 20,84 months. Results All the 12 donors were perfecthy recovered during operation and postoperation. During their 11-day stay in the hospital no complications was observed. The donor′creatinine was raised to about 12 to 34 μmol/L (mean, 22 μmol/L). One recipient died from lung infection at 28 days postoperative and 1 died due to liver failure with normal graft function after transplanted 6 months and yet one recipient with delayed graft function had recovered by 12 times dialysis.The remain recipient had a better recovered. Conclution Aged (≥55 years-old) donor renal transplantion can be carried out as the poor supply of can be used kidney but must to controled the idcation and the prepare to be accomplished seriously.