亲属活体供肾和DCD供肾肾移植的临床疗效比较
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摘要
目的:比较亲属活体供肾与心脏死亡器官捐献(donation after cardiac death,DCD)供肾肾移植的临床效果。方法:回顾性分析2011-04～2018-01兰州大学第二医院肾移植科同期完成的45例亲属活体供肾(亲属活体供肾组)和21例DCD供肾肾移植受者(DCD供肾组)的临床资料,比较两组患者移植肾一般情况、肾功能、人肾累积存活率及并发症情况。结果:两组患者性别、BMI、手术时间、住院时长比较,差异无统计学意义(P>0.05),供、受者年龄和透析时间比较,差异有显著统计学意义(P<0.01)。亲属活体供肾组和DCD供肾组受者急性排斥反应分别发生2例(4.4%)和6例(28.6%),两组间差异有统计学意义(P<0.05);移植肾功能延迟恢复分别发生1例(2.2%)和2例(9.5%),两组间差异无统计学意义(P>0.05)。术后1周两组患者血肌酐比较,差异均有统计学意义,且术后患者血肌酐恢复至正常的时间比较,差异有统计学意义(P<0.05或P<0.01);术后2周、1个月、2个月两组患者血肌酐差异均无统计学意义。两组整个随访期的人、肾累积存活率比较,差异无统计学意义。结论:亲属活体供肾与DCD供肾肾移植早期效果类似,活体肾移植在移植肾术后急性排斥反应及肾功能短期恢复方面具有一定优势,但随访期间的人、肾累积存活率相同。
Objective:To compare the clinical effects of relative living donor kidney and donation after cardiac death(DCD)donor kidney transplantation.Methods:The clinical data of45 cases of relative living donor kidney and 21 cases of DCD donor renal transplantation performed by the department of kidney transplantation of Lanzhou university second hospital from April 2011 to January 2018 was analyzed retrospectively.The general conditions,complications,renal function and cumulative survival rates of human and kidney between the two groups were compared.Results:There was no significant differences in gender,BMI,operation time,length of postoperative hospital stay between the two groups.There were significant differences in age and dialysis time between the two groups.There were 2 cases(4.4%)and 6 cases(28.6%)of acute rejection between the two groups,the difference was statistically significant(P<0.05).Delayed graft function occurred in 1 case(2.2%)and 2 cases(9.5%)respectively,there was no significant difference between the two groups(P>0.05).There was significant difference in serum creatinine between the two groups within the first week after surgery.The time to recovery of normal serum creatinine was statistically significant(P<0.05 or P <0.01).There was no statistically significant difference in serum creatinine between the two groups at 2 weeks,1 month,and 2 months after surgery.There was no significant difference in the cumulative survival rates of the human and kidney between the two groups during the entire follow-up period.Conclusion:The early effects of living relatives and DCD for kidney transplantation are similar.Relative living donor kidney transplantation has certain advantages in acute rejection and short-term recovery of renal function after transplantation,but the cumulative survival rates of human and kidney during follow-up is the same.
Objective:To compare the clinical effects of relative living donor kidney and donation after cardiac death(DCD)donor kidney transplantation.Methods:The clinical data of45 cases of relative living donor kidney and 21 cases of DCD donor renal transplantation performed by the department of kidney transplantation of Lanzhou university second hospital from April 2011 to January 2018 was analyzed retrospectively.The general conditions,complications,renal function and cumulative survival rates of human and kidney between the two groups were compared.Results:There was no significant differences in gender,BMI,operation time,length of postoperative hospital stay between the two groups.There were significant differences in age and dialysis time between the two groups.There were 2 cases(4.4%)and 6 cases(28.6%)of acute rejection between the two groups,the difference was statistically significant(P<0.05).Delayed graft function occurred in 1 case(2.2%)and 2 cases(9.5%)respectively,there was no significant difference between the two groups(P>0.05).There was significant difference in serum creatinine between the two groups within the first week after surgery.The time to recovery of normal serum creatinine was statistically significant(P<0.05 or P <0.01).There was no statistically significant difference in serum creatinine between the two groups at 2 weeks,1 month,and 2 months after surgery.There was no significant difference in the cumulative survival rates of the human and kidney between the two groups during the entire follow-up period.Conclusion:The early effects of living relatives and DCD for kidney transplantation are similar.Relative living donor kidney transplantation has certain advantages in acute rejection and short-term recovery of renal function after transplantation,but the cumulative survival rates of human and kidney during follow-up is the same.
引文
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[12]Matas A J,Smith J M,Skeans M A,et al.OPTN/SRTR2013annual data report:kidney[J].Amer J Transplant,2015,2(2):1-34.
[13]董永超,王养民,杨琦,等.亲属活体供肾移植与尸体供肾移植的临床疗效比较[J].西北国防医学杂志,2011,32(1):32-34.
[14]Garc A-Maset R,Pertch L G,Vallespin E V,et al.Living donor renal transplantation in Catalonia:overall results and comparison of survival with cadaveric donor renal transplantation[J].Transplant Proc,2005,37(9):3682-3683.
[15]张磊,陈正,马俊杰,等.两种不同供肾来源肾移植受体疗效的临床随访研究[J].临床泌尿外科杂志,2016,269(5):466-469.
[16]王欣宇,文定军,蒋宏毅,等.亲属活体肾移植与公民逝世后器官捐献肾移植术后并发症对比分析[J].中国医师杂志,2015,17(7):1067-1069.
[2]Zhang Q X,Xie J F,Zhou J D,et al.Impact factors and attitudes toward organ donation among transplantation patients and their caregivers in China[J].Transplant Proc,2017,49(9):1975-1981.
[3]韩锋,丁晨光,田普训,等.儿童器官捐献供肾肾移植疗效的临床研究[J].器官移植,2016,7(2):115-119.
[4]Groot I B,Veen J I,Van P J,et al.Difference in quality of life,fatigue and societal participation between living and deceased donor kidney transplant recipients[J].Clin Transplant,2013,27(4):415-423.
[5]Waterman A D,Morgievich M,Cohen D J,et al.Living donor kidney transplantation:improving education outside of transplant centers about live donor transplantation-recommendations from a consensus conference[J].Clin J Amer Soc Nephrol C,2015,10(9):1659-1669.
[6]Kutner N G,Johansen K L,Zhang R,et al.Perspectives on the new kidney disease education benefit:early awareness,race and kidney transplant access in a USRDS study[J].Amer J Transplant,2012,12(4):1017-1023.
[7]Mendeloff J,Ko K,Roberts M S,et al.Procuring organ donors as a health investment:how much should we be willing to spend[J]?Transplantation,2004,78(12):1704-1710.
[8]Simforoosh N,Basiri A,Tabibi A,et al.Laparoscopic donor nephrectomy-an Iranian model for developing countries:a cost-effective no-rush approach[J].Experi Clin Transplant,2004,2(2):249-253.
[9]Hart A,Smith J M,Skeans M A,et al.OPTN/SRTR2016annual data report:kidney[J].Amer J Transplant,2018,18(1):108-113.
[10]Purnell T S,Auguste P,Crews D C,et al.Comparison of life participation activities among adults treated by hemodialysis,peritoneal dialysis,and kidney transplantation:a systematic review[J].Amer J Kidney Dis,2013,62(5):953-973.
[11]Rodrigue J R,Kazley A S,Mandelbrrot D A,et al.Living donor kidney transplantation:overcoming disparities in live kidney donation in the US-recommendations from a consensus conference[J].Clin J Am Soc Nephrol,2015,10(9):1687-1695.
[12]Matas A J,Smith J M,Skeans M A,et al.OPTN/SRTR2013annual data report:kidney[J].Amer J Transplant,2015,2(2):1-34.
[13]董永超,王养民,杨琦,等.亲属活体供肾移植与尸体供肾移植的临床疗效比较[J].西北国防医学杂志,2011,32(1):32-34.
[14]Garc A-Maset R,Pertch L G,Vallespin E V,et al.Living donor renal transplantation in Catalonia:overall results and comparison of survival with cadaveric donor renal transplantation[J].Transplant Proc,2005,37(9):3682-3683.
[15]张磊,陈正,马俊杰,等.两种不同供肾来源肾移植受体疗效的临床随访研究[J].临床泌尿外科杂志,2016,269(5):466-469.
[16]王欣宇,文定军,蒋宏毅,等.亲属活体肾移植与公民逝世后器官捐献肾移植术后并发症对比分析[J].中国医师杂志,2015,17(7):1067-1069.