亲属活体肾移植101例分析

目的 总结16年亲属活体肾移植的经验。方法 101例亲属活体肾移植，除3例为夫妻间供肾外，其余为血缘亲属供肾。供、受者为同卵孪生2例，HLA全配24例，HLA单倍体相同69例，HLA有5个抗原错配者4例，HLA完全错配者2例。73例取供者右肾，28例取左肾；100例经开放手术取肾，1例经腹腔镜取肾。术后采用环孢素A（或他克莫司）、硫唑嘌呤（或霉酚酸酯）及泼尼松预防排斥反应。结果 所有供者术后1周内出院，随访6个月，血肌酐正常。术后96例受者存活，存活时间最长者达15年，其中4例移植肾功能丧失，其原因分别为超急性排斥反应（1例，术中切除肾脏）、慢性移植肾肾病与肾病复发（3例）；5例死亡，除1例术后发生移植肾功能恢复延迟，透析期间因肺出血死亡外，另4例死亡与移植肾无关。术后5例发生急性排斥反应，4例Banff分级为Ⅰ级，经甲泼尼龙冲击治疗，4例逆转，1例无效，恢复透析治疗。术后2例发生尿瘘，5例发生移植肾输尿管慢性梗阻，经手术治疗痊愈。结论 术前对供、受者进行全面综合评估是亲属活体肾移植成功的保证；亲属活体肾移植的组织配型好，供肾缺血时间短，排斥反应发生少，免疫抑制剂用量小，移植肾长期存活率高。

Living-related donor kidney transplantation-101 cases reports

Objective To introduce one-center experience on living-related donor kidney transplantation (LDKT).Methods One hundred and one patients underwent LDKT. Potential living donors (male 35, female 66) underwent fully medical evaluation before operation. Except for 3 cases being donated by spouse, the others were donated by blood relationship donors. Concerning donor- recipient HLA matching, 2 cases were identical twins, 24 cases shared two hapltypes, 69 cases shared one haplotype, 2 fully mismatch, and the other 4 with 5-coli mismatch. Except for one donor underwent laparoscopic nephrectomy, the others underwent open nephrectomy, in which 73 cases donated right kidneys and 28 cases donated left kidneys. Triple-combined immunosuppressive protocols consisted of calcineurin inhibitors (CNI), MMF/Aza and steroid.Results All donors were discharged in one week postoperation. Hematoma occurred in one case, wound infection in 2 cases, and slight pneumothorax in 5 cases. After follow-up for 2 months to 15 years, the donors kept normal kidney function without impairment of life quality, and 96 recipients with 92 grafts survived yet. One has survived for 15 years by now. Graft loss occurred in 4 cases due to superacute rejection, chronic allograft nephropathy and recurrent nephropathy. Five patients died, within which fatal hemorrhage in respiratory tract occurred in one patient with delayed graft function (DGF), and the other three died of other reasons unrelated to grafts. Acute rejection (AR) episodes occurred in 5 patients, among them 4 cases (grade 1, banff classification) were reversed successfully by high intravenous dose of methylprednisolone, nevertheless the other one failed and lost graft. Urological complications appeared in 7 patients-2 cases of urinary leak and 5 cases of late urinary obstruction.Conclusions Both ethics dilemmas and accurate pre-operation assessment of the donor and recipient are critical for the success. Optimal HLA matches and less ischemia time may result in low incidence of DGF and acute rejection, low-dose immunosuppressants, as well as long survival of kidney grafts.