心脏死亡器官捐献者供肾移植的可行性

 目的 总结心脏死亡器官捐献(donation after cardiac death, DCD)肾移植的临床资料,并探讨其可行性。方法 回顾性分析2012-04至2013-12武警总医院28例DCD和52例DCD供肾移植的临床资料。结果 28例DCD属于国际标准Maastricht Ⅲ类,共获取肾脏52个并实施肾移植52例。热缺血时间为(11.2±9.1)min,冷缺血时间为(4.1±2.2)h。12例发生移植肾功能延迟恢复(delayed graft function, DGF),发生率23.08%,均于术后20~72 d肾功能恢复正常。急性排斥反应发生率3.85％(2／52),分别于术后1、2周因移植肾破裂切除肾脏。受者死亡3例(术后3个月因巨细胞病毒性肺炎死亡1例,术后移植肾原发无功能并肺部真菌性肺炎1例,肾破裂术后感染性休克1例)。移植肾存活的47例受者,随访13~23个月,移植肾功能正常。结论 DCD 供体可以扩大供体来源,缓解器官短缺困难,但应注意并发症发生,提高移植效果。

A single-center experience of 52 cases of donation after cardiac death (DCD) for kidney transplantation

Objective To analyze the clinical effect of kidney transplantation using the donation after cardiac death(DCD)donors in this center, explore the feasibility of DCD and summarize the experience of DCD donor kidney transplantation. Methods From April 2012 to December 2013, the clinical data of 28 cases of DCD and 52 cases of DCD donor renal transplantation were retrospectively analyzed in this center. Results 28 DCD cases were performed by the classification of Maastricht Ⅲ criteria, resulting in fifty-two donated kidney for transplantations. Warm ischemic time of donor was (11.2±9.1)minutes, cold ischemic time of donor (4.1±2.2)h. Among 52 cases of kidney transplant recipients,postoperative renal delayed graft function (DGF) occurred in 12 cases (23.08%, 12/52), their renal function returned to the normal level from postoperative day 20 to 72. 2 cases were subjected to nephrectomy due to the rupture of the transplanted kidney caused by the irreversible acute rejection (3.85%, 2/52) in one week and two weeks after kidney transplantation. There was one death due to cytomegalovirus pneumonia after three months postoperatively, one death due to primary non-function of renal graft and fungal pneumonia, one death due to rupture of kidney and septic shock. 47 renal transplant recipients with graft survival were followed up for 13 to 23 months,and the grafts functioned properly. Conclusions Donor pool can be largely expanded with DCD donors,the occurrence of complications should be paid attention to and the effects of DCD transplantation should be improved.