亲属活体供肾移植62例经验

目的 总结活体供肾移植的临床经验,提高其临床疗效.方法 同顾分析62例活体供肾移植的临床资料及供者情况.62例中,60例为三代内直系亲属供肾,2例为夫妻问供肾.移植前按程序对供、受者进行评估.供、受者 ABO血型均相同,供、受者间补体依赖淋巴细胞毒均为阴性,受者群体反应抗体阳性2例.53例行HLA配型,其中无抗原错配者5例,1个抗原错配者5例,2个抗原错配者20例,3个抗原错配者18例,4个抗原错配者2例,5个抗原错配者2例,全错配者1例.取左肾51例,取右肾11例.采用抗CD25单克隆抗体及甲泼尼龙(MP)诱导者36例,单纯采用MP者26例.术后采用环孢素A(或他克莫司)霉酚酸酯及泼尼松方法排斥反应.结果 供者住院时间为(9.4±2.2)d,取肾前血肌酐(Cr)为(66.8±16.4)μmol/L,取肾后第1天、第7天以及3个月以后的血Cr分别为(109.3±23.6)ttmol/L、(101.1±24.4)μmol/L和(91.1±15.5)tanol/L,虽明显高于取肾前(P＜0.05),但仍在正常范围.供肾热缺血时间为(70.9±41.7)s,冷缺血时间为(148.2±37.4)min.供者术后的并发症有气胸(3例,4.8%)、淋巴漏(2例,3.2%),切口愈合延迟(2例,3.2%),经治疗后痊愈.受者随访最长者达42个月,人、肾1年存活率均为100%.术后并发症包括急性排斥反应6例(9.7%),移植肾功能恢复延迟4例(6.5%),移植肾破裂1例(1.6%),移植肾动脉吻合口狭窄1例(1.6%),骨髓抑制2例(3.2%),有症状的巨细胞病毒感染3例(4.8%),一过性肝功能异常12例(19.4%),结核2例(3.2%).结论 活体供肾移植的长期效果良好,并发症少;活体供肾是安全的;完善的术前评估程序是保障供、受者良好预后的关键之一.

Living related donor kidney transplantation:a clinical report of 62 cases

Objective To summarize the clinieal experience in living related donor kidney transplantation (LRKT).Methods A retrospective analysis of 62 recipients receiving LRKT was performed.Except for 2 cases being donated by spouse,the remaining cases were donated by blood relationship donors.Potentialliving donors underwent fully medieal evaluation before operation.As to HLA matching,43 cases shared one haplotype,5 cases shared two haplotypes,1 had full mismatch and the other 4 had 4 to 5-coli mismatch.Except for 5 donors undergoing laparoscopic nephrectomy,the others underwent open nephrectomy.Triple-combined immunosuppressive regimes included calcineurin inhibitors(CNI),mycophenolate mofetil and costisteroid.Results The average hospital stay of donors was(9.4±2.2)days.The mean warm/cold ischemia time of grafts was(70.9±41.7)s/(148.2±37.4)min respectively.Six donors were complicated with pneumothorax.Two cases had lymphatic leakage.During the follow-up,all of 62 donors recovered smoothly and suffered no complications.Six recipients had acute rejection.Four recipients were complicated with delayed graft function(DGF).One recipient had transplanted renal arteriaI stenosis (TRAS).Three cases had symptomatic CMV infection.The survival rate for patient/kidney was 100%/100%.Conclusion LRKT is proved to have good Iong-term outcome due to short ischemic time,less rejection,better tissue typing and lower dose of immunosuppressive agent. Strictly evaluating the procedure before operation is one of the keys to protect donors and recipients.