供肾穿刺活检在亲属活体肾移植中的应用及边缘供肾对受者预后的影响

目的 分析供肾穿刺活榆在亲属活体肾移植中对供肾质量的诊断价值及边缘供肾对亲属活体肾移植受者早期预后的影响.方法 2004年2月至2008年7月142例亲属活体肾移植患者,按照供体年龄和供肾情况分为边缘供者组(51例)和非边缘供者组(91例).并对49例亲属活体供肾行细针穿刺活检术.分析2组受者的术后血肌酐(Scr)变化、Scr最低值、所需时间、术后并发症发生率.结果 49例亲属活体供肾中13例发生病理改变.边缘供者组受者Scr在术后4周、12周、6月及最低Scr水平均高于非边缘供者组(均P＜0.05),而术后12个月、24个月、36个月Scr和Scr恢复至最低水平所需时间差异无统计学意义(均P＞0.05).边缘供肾受者术后并发症发生率与非边缘供肾受者差异无统计学意义.结论 边缘供肾受者的早期临床疗效是理想的,但术后血肌酐基线较非边缘供肾患者高,应严格控制其纳入标准.供肾穿刺活检有利于发现常规无创检查难以发现的潜在肾脏疾病,对供受者具有重要诊断和治疗价值.     

供肾穿刺活检在亲属活体肾移植中的应用及边缘供肾对受者预后的影响

目的 分析供肾穿刺活榆在亲属活体肾移植中对供肾质量的诊断价值及边缘供肾对亲属活体肾移植受者早期预后的影响.方法 2004年2月至2008年7月142例亲属活体肾移植患者,按照供体年龄和供肾情况分为边缘供者组(51例)和非边缘供者组(91例).并对49例亲属活体供肾行细针穿刺活检术.分析2组受者的术后血肌酐(Scr)变...     

边缘供者供肾对肾移植受者早期预后的影响

目的 分析边缘供者供肾对亲属活体肾移植受者早期预后的影响.方法 66例亲属活体肾移植病例按供体年龄和供体情况分为边缘供者组(28例)和非边缘供者组(38例).对照比较2组的手术前后患者SCr、内生肌酐清除率、内外科并发症等情况.结果边缘供者组和非边缘供者组受者在术后第7天、1和3个月SCr分别为154、131、127μmol/L和132、117、118/μmol/L,2组之间比较差异无统计学意义(P＞0.05);2组父母子女间供肾受者的SCr在术后第7天、1、3个月分别为160、131、126 μmol/L和132、129、126μmol/L,2组之间比较差异均无统计学意义(P＞0.05)}边缘供者供肾受者内外科并发症发生率、内生肌酐清除率与非边缘供者供肾受者比较差异无统计学意义.结论 边缘供者供肾的早期临床疗效理想.严格控制其纳入标准,边缘供者尤其父母子女间的边缘供者可作为亲属活体肾移植供体.     

亲属活体供肾动脉轻度狭窄对肾移植受者术后早期肾功能和并发症的影响

目的探讨亲属活体供肾动脉轻度狭窄对肾移植受者术后早期肾功能和并发症的影响。方法回顾性分析14例供肾动脉轻度狭窄的亲属活体肾移植与50例标准亲属活体肾移植供、受者的临床资料。比较两组供者术后血清肌酐(Scr)水平。比较两组受者术后1、3、6个月的Scr水平;比较两组受者移植肾存活率及移植物功能延迟恢复(DGF)、急性排斥反应、肺部感染的发生率。结果两组供者术后Scr水平比较,差异均无统计学意义(均为P0.05)。两组术后1、3、6个月Scr水平比较,差异均无统计学意义(均为P0.05)。两组受者移植肾存活率,DGF、急性排斥反应、肺部感染的发生率比较,差异亦均无统计学意义(均为P0.05)。结论亲属活体供肾动脉轻度狭窄对肾移植受者术后肾功能和并发症的影响不大,可纳入标准供体供肾范围。     

老年活体供肾移植术后供者安全性及受者移植效果的分析

目的 分析老年活体供肾移植术后供者的安全性及受者的移植效果.方法 回顾性分析251例亲属活体供肾移植的临床资料.根据供者年龄,将251例活体供肾移植分为老年供肾组(≥55岁)和中青年供肾组(<55岁),对手术前后两组供、受者的血清肌酐(Cr)、肾小球滤过率(GFR)、内生肌酐清除率(Ccr)、并发症、平均住院时间以及受者的人/肾存活率、急性排斥反应发生率进行比较和分析.结果 老年供肾组和中青年供肾组供者手术前后血Cr水平的差异无统计学意义(P>0.05),而Ccr的差异有统计学意义(P<0.05).老年供肾组与中青年供肾组供者比较,术前总GFR、留存肾GFR及术后10 d留存肾GFR比较,差异均无统计学意义(P>0.05);老年供肾组供者术后10 d与术前的留存肾GFR比较,差异无统计学意义(P>0.05);中青年供肾组供者术后10 d的留存肾GFR较术前明显上升,差异有统计学意义(P<0.05).老年供肾组与中青年供肾组受者比较,手术前后各相应时间点的血Cr水平差异无统计学意义(P>0.05).老年供肾组和中青年供肾组供者平均住院时间分别为(16.67±7.78)d和(16.11±5.89)d(P>0.05),受者平均住院时间分别为(29.61±24.28)d和(28.76±19.27)d(P>0.05).两组受者6个月内急性排斥反应发生率分别为6.50%和5.75%(P>0.05).老年供肾组受者术后死亡1例,中青年供肾组死亡3例,并有1例因急性排斥反应切除移植肾.结论 老年活体供肾移植术前应对供者进行严格的选择,在进行全面系统评估的前提下,可以保证供者术后的安全以及受者的移植效果.     

亲属活体供肾移植52例随访

目的 调查分析亲属活体供肾移植供、受者术后的肾功能及生活质量情况.方法 以行亲属活体供肾移植的供受者52对、接受尸体肾移植的受者56例以及随机抽取的同期健康人60名为研究对象.于移植术前、术后3个月和1年对研究对象进行调查,采用调查问卷和临床检验相结合的方式.调查内容包括年龄、性别、婚姻状况、供受者的关系等以及健康状况调查问卷SF-36量表.结果 供者术后3个月及1年的血Cr和24 h尿蛋白均高于术前,但未超过正常范围.供者术前、术后3个月及1年的血Cr、GFR和24 h尿蛋白与健康人相比,差异均无统计学意义(P>0.05).活体供肾移植受者术后3个月及1年的血Cr与BUN均低于相应时间点的尸体肾移植受者,差异有统计学意义(P<0.05).供者术后3个月及1年的生活质量与术前相比,差异均无统计学意义(P>0.05);供者术前、术后3个月及1年的生活质量与健康人相比,差异均无统计学意义(P>0.05).活体供肾移植受者术后3个月及1年的生活质量与相应时间点的尸体肾移植受者相比,差异均无统计学意义(P>0.05).结论 活体供肾移植供者在切除肾脏后肾功能未见减退,生活质量与健康人群相比无明显差异;受者术后的移植肾功能恢复明显优于尸体肾移植受者.     

活体亲属供肾移植12例报告

目的 探讨活体亲属供肾移植的安全性、可行性,并评价活体亲属供肾移植的临床效果。方法 对１２例活体亲属供肾移植的资料进行分析。结果 １２名供者均无并发症出现,术后７～９ｄ出院。１例受者术后移植肾功能延迟至第６周恢复正常;１例受者出现急性排斥反应,应用激素冲击治疗３ｄ后逆转;余１０例受者肾功能均恢复良好。随访满６个月的８例受者,其血尿素氮、肌酐和内生肌酐清除率分别为８．２ｍｍｏｌ／Ｌ、９７．２μｍｏｌ     

活体亲属供肾的肾移植5例报告

目的 探讨活体亲属供肾移植及术前特异性输供体血的安全性及可行性,并评价其临床效果。方法 总结5例活体亲属供肾移植的临床效果和供肾者术后的恢复情况。结果 5例活体亲属供肾者经随访10～24月全部健康,正常工作,术后无明显的并发症,5例肾移植受者目前移植肾功能(血肌酐及内生肌酐清除率)均正常,且已恢复正常的学习和工作,术后的免疫抑制剂使用量较同期的尸体肾移植受者低10％～15％。结论 活体亲属供肾是扩大供肾来源的较好途径,移植术后人/肾存活率优于尸体肾移植人/肾存活率。术前特异性输供体血有利于诱导受者产生免疫耐受。     

亲属活体供肾移植83例临床分析

目的 总结亲属活体供肾移植的临床经验.方法 83例活体亲属供肾移植,其中血缘亲属供肾79例,夫妻间供肾4例.术前对供者进行全面综合评估,包括心理评估.73例采用开放手术取肾,10例经腹腔镜取肾.除接受同卵双生供肾移植的1例不用免疫抑制剂外,其余82例术后采用环孢素A(或他克莫司)、霉酚酸酯(或硫唑嘌呤,或咪唑立宾)及泼尼松预防排斥反应.结果 术后无肾功能恢复延迟发生,8例发生急性排斥反应,经甲泼尼龙冲击或抗淋巴细胞球蛋白治疗后全部逆转.术后随访1个月至8年,所有供者恢复良好,血肌酐正常;83例受者中,死亡2例,1例术后2年死于呼吸衰竭,1例术后7年死于心力衰竭.结论 术前应对供者进行全面综合评估,取肾应采用术者最熟练最有把握的方法;缩短受者术前透析时问,术后早期免疫抑制剂的用量应同尸体肾移植,但维持用药可采用较低剂量.     

活体亲属供肾肾移植10例报告

目的：总结活体亲属供肾肾移植的临床经验。方法：回顾性总结10例活体亲属供肾肾移植患者的临床效果及供者捐肾后的情况。结果：10例供者供肾后未出现严重的并发症,术后7～10天出院。10例受者均为首次肾移植,术后6～24个月随访,肾功能恢复良好,仅1例出现急性排斥反应,经激素冲击治疗后逆转,人／肾存活率为100％。结论：活体亲属供肾肾移植是安全可行的,受者人／肾存活率优于尸体供肾;活体亲属供肾是扩大供肾来源的较好途径。     

Effect of donor age on the outcome of living-related kidney transplantation

The study compared the results of kidney transplantation from living-related donors older and younger than 60 years. The 273 kidney graft recipients were divided into group 1 (115 recipients of older grafts) and group 2 (158 recipients of younger grafts). The frequency of acute rejection (AR) episodes was similar in both groups but slow graft function occurred more frequently in group 1. The frequency of chronic renal allograft dysfunction in the first post-transplant year was significantly higher in group 1 than in group 2. Patient and graft survival was significantly worse in group 1. Risk factors for graft loss were the difference between donor and recipient age and AR. Donor age and graft function were risk factors for patient death. Although kidneys from older donors provide a statistically poorer transplant outcome, they are clinically acceptable, especially when waiting time is prolonged and access to dialysis limited.     

Pre-existing arteriosclerotic intimal thickening in living-donor kidneys reflects allograft function

Background: Donor shortage is a serious problem worldwide and it is now debated whether kidneys from marginal donors are suitable for renal transplantation. Recent studies have shown that the findings of preimplantation kidney biopsy are useful to evaluate vasculopathy in the donated kidney, and may predict transplant outcomes in deceased- donor kidney transplantation. However, few studies have focused on the pathological findings of preimplantation biopsy in living-donor kidney transplantation. Therefore, we investigated whether arteriosclerotic vasculopathy in living-donor kidneys at the time of transplantation predicts the recipient's kidney function (allograft function) later in life. Methods: We retrospectively analyzed 75 consecutive adult living-donor kidney transplants performed at Kagawa University Hospital. Renal arteriosclerotic vasculopathy was defined according to the presence of fibrous intimal thickening in the interlobular artery. Results: Forty-one kidneys exhibited mild arteriosclerotic vasculopathy on preimplantation kidney biopsies. The decreases in estimated glomerular filtration rate after donation were similar in donors with or without renal arteriosclerotic vasculopathy. Pre-existing arteriosclerotic vasculopathy did not affect graft survival rate, patient survival rate or the incidence of complications. Recipients of kidneys with arteriosclerotic vasculopathy had lower allograft function at 1 and 3 years after transplantation than the recipients of arteriosclerosis-free kidneys with or without donor hypertension. In multivariate analysis, fibrous intimal thickening on preimplantation biopsy was predictive of reduced allograft function at 1 year after transplantation. Conclusions: The present study demonstrated that mild arteriosclerotic vasculopathy in the donated kidney is an important pathological factor that reflects future impaired function of renal allografts from marginal donors.     

Gender-related differences of renal mass supply and metabolic demand after living donor kidney transplantation

Kidney donation from female donors to male recipients has been reported to be associated with decreased allograft survival. Whether there was a gender-related inadequacy between donor nephron supply and recipient functional demand was investigated in this study. One hundred ninety-five living donor kidney transplant recipients that had neither ischemic injury, episode of rejection, nor any complication were included. Weights and heights of both donors and recipients were recorded to calculate body surface area, lean body weight, and body mass index. The donated kidney was weighed just after cold flush, and the recipient's serum creatinine (Scr) was measured on a daily basis post-operatively. When the recipient's Scr reached the baseline, a 24-h urine was collected for the amount of proteinuria (Upr), creatinine excretion (Ucr) and creatinine clearance (Ccr) calculation. The effect of donor and recipient gender was analysed by independent sample t-test. On average, male donors and recipients were heavier and taller than females. However, the mass of kidneys donated from men and women were not statistically different. The gender-related differences in post-transplant Scr and Ucr of recipients were associated with the differences in the parameters of metabolic demands of recipients rather than with the weight of implanted kidney (renal mass supply) or with pre-operative renal functions of donors (functional supply). The early graft function is not determined by donor gender. The effect of recipient gender on the graft function depends on the metabolic demands, which are higher in male recipients.     

Renal allograft survival according to primary diagnosis: a report of the North American Pediatric Renal Transplant Cooperative Study

The data base of the North American Pediatric Renal Transplant Cooperative Study (NAPRTCS) was used to examine the effect of primary diagnosis on the outcome of renal transplantation in children. The relative risk of graft failure for eight diagnostic groups was determined, with patients with congenital and structural anomalies of the urinary tract serving as the reference group. Covariate analysis was used to control for the effects of age, race and transfusion history in recipients of living-related donor kidneys, and for age, donor age, antilymphocyte prophylaxis, prior transplantation, prior dialysis and cold ischemia time in recipients of cadaver kidneys. In recipients of living-related donor kidneys, the lowest graft failure rates were associated with the diagnoses of cystinosis, familial nephritis and hemolytic uremic syndrome (HUS), while the highest failure rates were observed in patients with a primary diagnosis of congenital nephrotic syndrome (CNS) or focal segmental glomerulosclerosis (FSGS). In cadaver allograft recipients, the lowest graft failure rates were associated with primary diagnoses of glomerulonephritis, congenital/structural disease and cystinosis, while patients with FSGS, HUS and CNS had the highest graft failure rates. This study suggests that patients with a primary diagnosis of cystinosis have superior outcomes, while the diagnoses of FSGS and CNS carry with them the highest risks of graft failure.     

扩大标准公民逝世后器官捐献肾移植术后一年内临床效果分析

目的观察并比较扩大标准供者(ECD)和标准供者(SCD)供肾移植受者术后1年内临床效果。 方法回顾性分析2014年3月至2017年3月空军军医大学西京医院接受公民逝世后器官捐献90例肾移植受者临床资料,按供肾来源分为ECD组(31例)和SCD组(59例)。所有受者均应用免疫诱导及三联免疫抑制方案治疗(吗替麦考酚酯或麦考酚钠肠溶片＋他克莫司或环孢素＋甲泼尼龙)。采用t检验或Mann-Whitney U检验比较两组受者肾移植术后1年内血清肌酐(Scr)水平,采用χ²检验和Fisher确切概率法比较两组受者性别比例、受者/移植肾存活率及急性排斥反应(AR)、移植肾功能延迟恢复(DGF)和肺部感染等并发症发生率。P<0.05为差异有统计学意义。 结果ECD组和SCD组肾移植受者术后Scr水平逐步下降。术后1个月内(术后1、3、7、14和21 d)两组受者Scr水平差异均无统计学意义(t＝0.076、0.905、0.670、0.893和0.048,P均>0.05);术后1～12个月,除术后9个月两组受者Scr水平差异无统计学意义(t＝1.727,P>0.05),其余各时间点ECD组受者Scr水平均高于SCD组,差异均有统计学意义(P均<0.05)。两组受者术后1年受者/移植肾存活率分别为93.1%/80.6%和91.5/84.7%,差异均无统计学意义(P＝0.734; χ²＝0.246,P>0.05)。ECD组和SCD组AR发生率分别为12.9%(4/31)和18.6%(11/59),DGF发生率分别为22.6%(7/31)和22.0%(13/59),肺部感染发生率分别为25.8%(8/31)和11.9%(7/59),其他并发症发生率分别为41.9%(13/31)和28.8%(17/59),差异均无统计学意义(P均>0.05)。 结论与SCD相比,ECD供肾移植仍可获得相当的临床效果。在目前供器官来源严重缺乏的情况下,ECD的合理选择可以扩大供肾来源。     

Pretransplant Biopsy of Marginal Kidneys: Is It Necessary?

IntroductionPretransplant kidney biopsy from marginal donors is used to guide the decision of whether to accept or discard organs for transplantation; however, there is controversy about this procedure, and the need for a pretransplant biopsy is still a debate. We sought to determine if histologic evaluation before implantation of marginal kidneys would influence the outcome. Methods. A retrospective observational cohort study of marginal donor transplants at Centro Hospitalar e Universitário de Coimbra was done. From 2009 to 2016, 650 marginal kidney transplants were analyzed. We evaluated long-term graft survival in a cohort of patients who received marginal kidneys. The recipients were divided into 2 groups based on whether a pretransplant donor biopsy was performed. Continuous variables were summarized by mean and standard deviation or median and range, as applicable. Categorical variables were summarized by relative and absolute frequencies. The survival analysis was obtained and plotted using the Kaplan-Meier method and compared with the log-rank test.ResultsThe median age of recipients and donors were statistically different between both groups (P < .001), with the donors and the recipients being younger in the group without a pretransplant biopsy. The median cold ischemia time was higher in the biopsy group (P = .01). The survival analysis showed that graft survival didn't differ between the groups (P = .2).ConclusionsSelection of kidneys based on histological findings may not influence the graft survival and implies a higher cold ischemia time. More data are necessary to provide insight into which clinical, histologic, and biochemical parameters are necessary for decision making on kidney acceptance.     

Outcome in emotionally related living kidney donor transplantation

Background. The growing shortage of cadaver kidneys, the limited possibilities to expand the living related donor pool and the good results obtained in our centre with poorly matched cadaver kidneys, led us in 1991 to begin accepting highly motivated, unrelated, living kidney donors who had a strong emotional bond with the recipients. Methods. Between 1 January 1991 and 1 January 1996, 46 potential living kidney donors and their emotionally related recipients were evaluated. Twenty-three cases were accepted for renal transplantation after thorough somatic and psychological evaluation. The mean post-transplant follow-up until 1 April 1996 was of 28±3 months. Compatible blood groups and a negative cross-match were mandatory, but no minimal HLA matching was required. Results. There was a 50% drop-out rate following the initial screening. The main reasons for not performing transplantation were immunological contraindications in 39% of the cases, somatic in 30.5%, psychological in 26% and socioeconomic in 4.5%. In the accepted group of recipients, 48% (11/23) received transplants without chronic dialysis. Donor survival was 91%; two deaths unrelated to nephrectomy occurred 1 year after donation. The 2-year actuarial recipient and graft survivals were 100% and 91% respectively, compared to 99% (recipients) and 93% (grafts) in the non-HLA-identical living related kidney transplant group, and to 93% (recipients) and 83% (grafts) in the cadaver kidney transplant group. Recipient rehabilitation was completed after 4±1 months. Emotionally related donors returned to work 5±2 weeks after nephrectomy, and no donor regretted his decision, even in the case of failure. Conclusions. Kidney transplantation from emotionally related living donors represents a valuable option, allowing more patients with end-stage renal disease to avoid chronic dialysis. Recipient and graft outcome were superior to cadaver kidney transplantation. Motivated and emotionally related donors should be allowed to donate one of their kidneys provided that they are carefully selected and thoroughly informed.