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长征-1号多器官保存液效果的动物实验研究 总被引:5,自引:0,他引:5
目的 研究长征1 号(CZ1) 多器官保存液对肾脏低温保存的有效性及移植存活率的影响。 方法 (1) 采用离体肾脏灌注模型,分别检测了低温延时保存后兔肾线粒体呼吸控制率(RCR)、Na+K+ATPase 活性、皮质线粒体Ca2 + 、皮质ATP等含量的变化。(2) 采用SD 大鼠肾脏移植模型,分别观察了低温延时保存48 、72 小时后再移植,大鼠存活以及移植肾功能恢复情况。 结果 (1)CZ1 液组保存72 小时,其生化指标肾脏线粒体呼吸控制率、皮质线粒体Ca2+ 、皮质ATP含量的变化均优于UW 液组;(2)经UW 液和CZ1 液低温保存供肾48 小时,7 天之内肾功能恢复正常。保存供肾72 小时,14 天之内肾功能基本接近正常。 结论 长征1 号多器官保存液对肾脏低温保存效果基本类同于UW 液,且部分生化学结果优于UW 液。 相似文献
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目的探讨活体肾移植对供者安全性的影响。方法研究对象为2003年4月至2007年4月在新疆医科大学第一附属医院完成活体供肾肾移植的62例供者。记录供者手术时间和住院时间,观察术后并发症发生情况和预后情况。术后随访,随访内容包括血清肌酐(Scr)、血尿素氮(BUN)、肾小球滤过率(GFR)、血浆白蛋白、血红蛋白及血压等指标,同时调查供肾对生活工作的影响。结果62例供者供肾手术均获成功。供者中1例开放取肾术中发生气胸,1例发生切口脂肪液化坏死,经对症治疗后痊愈。2例术后并发肺部感染,选用敏感抗生素及雾化吸入治疗后治愈,其余术后均恢复顺利。62例供者平均术后住院时间(8.2±2.6)d,随访时间为(3.2±1.1)年。所有供者均存活,家庭生活和日常工作也未受到明显影响。62例供者术前及术后7 d、3个月、1年、3年、5年的Scr、BUN、GFR、血浆白蛋白、血红蛋白及血压变化情况比较,差异无统计学意义(均为P0.05)。结论活体供肾肾切除手术安全可行。严格完善术前检查,术中仔细操作及术后严密随访对于保障供者的安全有十分重要的意义。 相似文献
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探讨亲属活体肾移植供者的选择评估及围手术期安全性.方法 2007年6月至2010年8月,广西中医学院附属瑞康医院移植泌尿外科严格按照供体的评估程序,对79例拟行亲属活体肾移植的供体进行评估,依据供者入选和剔除标准选出合格供体.所有患者均签署知情同意书,符合医学伦理学规定.对供、受者的临床资料进行回顾性分析.收集供者的一般资料、肾功能、捐献关系,分析拟供者剔除的原因,了解供、受者的配型、手术情况,追踪供者、受者术后随访情况.结果 79名拟供者,经严格的筛选最终确定为亲属活体肾移植供体38名.剔除的41例中,糖尿病和高血压,占34%,其余依次为双侧肾功能损害、患乙型病毒性肝炎或丙型病毒性肝炎.供、受者的关系:父母捐献给子女15名,3代以内血亲捐献10名,兄弟之间捐献8名,夫妻之间捐献5名.供、受者血型相同33对、相容5对.供、受者补体依赖淋巴细胞毒性试验均为(-)、群体反应性抗体均为(-).供者手术时间1~2 h,供肾热缺血时间30~60 s,冷缺血时间1~2 h.供者术前及术后的血清肌酐水平都有不同程度的升高,但均于术后7 d恢复正常.供者围手术期间均未发生外科及内科并发症,住院时间10~14 d.本组受者中,除1例夫妻之间捐献的肾移植患者术后发生急性排斥反应外,其他病例无出现急性排斥反应、肾功能延迟恢复等状况,随访至2010年7月,移植肾均正常.结论 对于亲属活体肾移植的供体安全应予重视.严格进行术前评估,选择合格的供者,术中操作规范,术后加强管理,活体肾移植的供者围手术期是安全的. 相似文献
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目的探讨新疆维吾尔族自治区(新疆)少数民族亲属活体肾移植中供肾切除术对供体安全性的影响。方法对55例活体肾移植供体进行随访,复查肾功能、24 h尿蛋白定量等常规检查,并与供者进行沟通,了解其心理状况和生活质量。对供者术前、术后7 d、术后6个月、术后1年、术后3年、术后5年的血清肌酐(Scr)、内生肌酐清除率(Ccr)和血压进行比较。结果 55例供体中,术后出现气胸1例,切口延迟愈合2例,切口血肿4例,经处理后均恢复正常,平均住院时间11 d。随访6~86个月,其中2例供者术后6个月内尿红细胞3~5/HP,2例出现一过性蛋白尿。术后供体各时段的肾功能(Scr和Ccr)和血压(收缩压与舒张压)均在正常范围内,术后7 d、6个月、1年、3年、5年的Scr、Ccr、血压与术前相应指标比较,差异均无统计学意义(均为P>0.05)。在随访期间所有供体家庭生活和日常工作未受到影响。结论新疆少数民族亲属活体供肾是安全可行的,供者在捐肾后肾功能未见减退,且生活质量较好。 相似文献
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S. Takahara T. Moriyama Y. Kokado T. Hanafusa K. Yazawa S. Yi T. Tanaka Y. Kojima T. Tabata K. Oka E. Imai 《Clinical and experimental nephrology》2002,6(4):0242-0247
Background. Prolonging the survival of transplanted kidneys is one of major tasks of modern nephrology. Angiotensin-converting enzyme
inhibitors (ACEIs) compose a class of antihypertensive agents that has established efficacy in the treatment of hypertension
and in slowing the progression of diabetic nephropathy and chronic glomerulonephritis. ACEIs are not widely accepted as a
standard medication in the treatment of hypertension in renal transplant recipients because of the potential risk for decreased
renal blood flow and glomerular filtration rate associated with a single kidney and concomitant cyclosporin use.
Methods. We undertook a prospective randomized study of ACEI (benazepril) treatment in 76 posttransplant patients to determine the
safety, efficacy, and side-effect profile of benazepril. Forty-one patients were assigned to the benazepril group and 35 patients
were assigned to the control group.
Results. The mean arterial blood pressure at a 12-month follow-up was lower than that at the time of initiation of benazepril or control
therapy, with a decrease from 101 ± 10 mmHg to 94 ± 7 mmHg (P < 0.05) in the benazepril group and from 102 ± 12 mmHg to 94 ± 10 mmHg in the control group after 12 months of treatment.
The serum creatinine concentrations did not change throughout the follow-up period.
Conclusions. Benazepril was demonstrated to be an effective antihypertensive without any unfavorable effects on graft function. A significant
antiproteinuric effect of benazepril was observed in patients with overt proteinuria. Further follow-up of this patient population
will contribute to the establishment of the long-term renoprotective effect of benazepril in renal allograft recipients.
Received: June 12, 2002 / Accepted: August 5, 2002
Correspondence to:T. Moriyama 相似文献
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Negative impact of prolonged cold storage time before machine perfusion preservation in donation after circulatory death kidney transplantation 下载免费PDF全文
Siegfredo Paloyo Junichiro Sageshima Jeffrey J. Gaynor Linda Chen Gaetano Ciancio George W. Burke 《Transplant international》2016,29(10):1117-1125
Kidney grafts are often preserved initially in static cold storage (CS) and subsequently on hypothermic machine perfusion (MP). However, the impact of CS/MP time on transplant outcome remains unclear. We evaluated the effect of prolonged CS/MP time in a single‐center retrospective cohort of 59 donation after circulatory death (DCD) and 177 matched donation after brain death (DBD) kidney‐alone transplant recipients. With mean overall CS/MP times of 6.0 h/30.0 h, overall incidence of delayed graft function (DGF) was higher in DCD transplants (30.5%) than DBD transplants (7.3%, P < 0.0001). In logistic regression, DCD recipient (P < 0.0001), longer CS time (P = 0.0002), male recipient (P = 0.02), and longer MP time (P = 0.08) were associated with higher DGF incidence. In evaluating the joint effects of donor type (DBD vs. DCD), CS time (<6 vs. ≥6 h), and MP time (<36 vs. ≥36 h) on DGF incidence, one clearly sees an unfavorable effect of MP time ≥36 h (P = 0.003) across each donor type and CS time stratum, whereas the unfavorable effect of CS time ≥6 h (P = 0.01) is primarily seen among DCD recipients. Prolonged cold ischemia time had no unfavorable effect on renal function or graft survival at 12mo post‐transplant. Long CS/MP time detrimentally affects early DCD/DBD kidney transplant outcome when grafts were mainly preserved by MP; prolonged CS time before MP has a particularly negative impact in DCD kidney transplantation. 相似文献
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J P Vroemen J A van der Vliet B Cohen G G Persijn Q Lansbergen G Kootstra 《European surgical research. Europ?ische chirurgische Forschung. Recherches chirurgicales européennes》1984,16(3):175-181
The influence of warm and cold ischemic time (WIT and CIT) on renal allograft function and allograft survival rates was analyzed from the Eurotransplant data. From 1977 through 1980 renal allograft recipients were divided into three groups, according to the length of the WIT of their graft: group I, 0-10 min (n = 2,636); group II, 11-20 min (n = 108); group III, 21-35 min (n = 17). Differences in graft function or graft survival have not been observed between these groups. It is concluded that donor kidneys with a WIT up to 20 min are acceptable for transplantation. The transplantation results in group III suggest that 35 min is a safe limit for acceptance, but the small number of transplantations in this group does not justify a firm conclusion. A combined analysis of warm and cold ischemia shows that simple cold storage up to 50 h is safe and acceptable, provided that warm ischemia is kept minimal (less than 10 min). It seems advisable to keep hypothermic preservation within the limit of 30 h, when WIT exceeds 10 min. 相似文献
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D C Dafoe D A Campbell W H Marks A Borgstrom R M Merion R E Berlin J G Turcotte 《Surgery》1986,99(2):170-177
Transplantation of the pancreaticoduodenal allograft (PDA) has recently been advocated as a technique that is superior to the use of the segmental allograft. However, the effect of simple cold storage preservation on the PDA has not been studied. We investigated the effect of 24 and 4 hours of cold storage in Eurocollins solution on porcine PDA function after transplantation in pancreatectomized pigs. A regimen of cyclosporine and prednisone was used, which prevented rejection for at least 28 days after transplantation. Cold storage preservation for 24 hours uniformly resulted in PDA failure. Compared with recipients of immediately transplanted PDA, recipients of PDA cold stored for 4 hours had marked plasma hyperamylasemia (10,000 U/L versus 1932 U/L), relative glucose intolerance (K value -2.15 versus -2.66), hypoinsulinemia (peak immunoreactive insulin 11.0 microU/ml versus 34.7 microU/ml), and an abnormal pattern of insulin secretion as demonstrated with intravenous glucose tolerance testing. There was also a higher incidence of technical complications in the group transplanted with cold-stored PDAs. Our results suggest that there is a detrimental effect on porcine PDA function after only 4 hours of cold storage in Eurocollins solution. 相似文献
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García-Maset R Perich LG Vallespin EV Escayola MC Gómez JM Puigjaner RS;Catalan Renal Registry 《Transplantation proceedings》2005,37(9):3682-3683
OBJECTIVES: To describe the general characteristics of living-donor renal transplantation (LRT) in Catalonia, and to compare results with those of the cadaveric donor renal transplant (CRT). RESULTS: Four hundred seventy-three LRTs have been performed in Catalonia since 1965. Transplantations carried out between 1980 and 2003, according to the RMRC data, were reviewed. The most frequent degrees of kinship are parents-children (48%), spouses (22%), and siblings (18%). Around 68% of the donors were women. Around 56% of recipients were men. The transplant was advanced in approximately 30% of the cases. The mean cold ischemia was 2 hours. Seven percent showed delayed graft function (DGF). Forty-nine percent of the patients had glomerular filtration >60 mL/min after 1 year. Patient survival at 1, 5, 10, and 20 years were 99%, 97%, 93%, and 82% in LRT; and 96%, 90%, 80%, and 62% in CRT (P < .00001). Graft survivals over the same periods were 91%, 76%, 58%, and 32% in LRT, and 85%, 69%, 49%, and 23% in CRT (P = .00008). The graft mean life was 12 years (LRT) and 10 years (CRT). Graft survivals, censoring deaths over the same periods, were 93%, 79%, 62%, and 39% in LRT, and 89%, 77%, 62%, and 37% in CRT (P = .3). Mean life was 14 years in both cases. The recipients mean age was 31 (LRT), and 44 years (CRT), whereas the donor mean age was 51 (LRT), and 42 years (CRT). CONCLUSIONS: LRT results were excellent both regarding DGF and patient and graft survivals. They were not comparable to CRT due to the different characteristics of the recipients. LRT is a good solution to reduce waiting lists. 相似文献
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Influence of donor pretreatment with dopamine on allogeneic kidney transplantation after prolonged cold storage in rats 总被引:4,自引:0,他引:4
Gottmann U Notheisen A Brinkkoetter PT Yard BA Waldherr R Schnuelle P van der Woude FJ Braun C 《Transplantation》2005,79(10):1344-1350
BACKGROUND: Retrospective transplant database analysis revealed that administration of catecholamines to organ donors reduces acute rejection episodes and improves graft survival after renal transplantation. In the present study, the authors investigated the influence of dopamine donor pretreatment before prolonged cold storage on short- and long-term graft outcome after allogeneic kidney transplantation. METHODS: Fisher donor rats were treated intravenously for 24 hr with dopamine or isotonic saline, Lewis rats treated with saline served as controls. Explanted kidneys were stored for 24 hr at 4 degrees C in University of Wisconsin solution and transplanted into Lewis rats. RESULTS: Dopamine pretreatment markedly reduced the infiltration of monocytes down to the level of isogeneic controls 5 days after allogeneic transplantation and hastened recovery of renal function in the first days after transplantation. After 24 weeks, serum creatinine and proteinuria were significantly lower in recipients of dopamine-treated grafts. Histologically, dopamine donor pretreatment significantly reduced the severity of chronic allograft nephropathy. Survival of animals that underwent transplantation was improved by dopamine pretreatment of donors (P=0.04). CONCLUSIONS: Pretreatment of organ donors with dopamine improves short- and long-term outcome after prolonged cold storage and subsequent allogeneic kidney transplantation in rats. The authors' experimental data demonstrate that donor treatment is a simple and effective approach for preventing long-term graft loss after kidney transplantation. 相似文献
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Ikegami T Shirabe K Soejima Y Taketomi A Yoshizumi T Uchiyama H Harada N Maehara Y 《Clinical transplantation》2012,26(1):143-148
Ikegami T, Shirabe K, Soejima Y, Taketomi A, Yoshizumi T, Uchiyama H, Harada N, Maehara Y. The impact of renal replacement therapy before or after living donor liver transplantation. Clin Transplant 2012: 26: 143–148. © 2011 John Wiley & Sons A/S. Abstract: Introduction: The impact of renal replacement therapy (RRT) in living donor liver transplantation (LDLT) has not yet been investigated. Methods: Among 253 LDLT patients, RRT was started before (RRT‐Pre, n = 9), or after (RRT‐Post, n = 27) LDLT. The clinical outcomes were reviewed. Results: The one‐yr graft survival rate was 94.1% without RRT, and 63.9% and in those with RRT (p < 0.0001). Among the RRT patients, the RRT‐Pre patients exhibited acute liver failure, hepatorenal syndrome and high model for end‐stage liver disease score (35 ± 12), whereas the RRT‐Post patients had sepsis as a comorbidity. The one‐yr graft survival rate was 100.0% in the RRT‐Pre patients vs. 51.9% in the RRT‐Post patients (p < 0.01). The duration of RRT was significantly shorter in the RRT‐Pre patients than that in the RRT‐Post patients (5.3 ± 2.1 vs. 17.8 ± 14.1 d, p = 0.02). The mean duration between starting RRT and LDLT was 2.1 ± 0.7 d in the Pre‐RRT patients. Conclusion: The RRT‐Pre patients had excellent outcomes because the severe condition was primarily treated by LDLT after short‐term pre‐transplant RRT. Post‐transplant uncontrollable sepsis was the major cause of graft loss in patients who receive RRT after LDLT. 相似文献
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INTRODUCTION: To provide greater equity among those awaiting a liver transplant, expanded geographic sharing of cadaveric organs has been proposed. A potential unintended consequence could be an increase in cold ischemia time (CIT), which may be deleterious to organs from older donors. This study sought to quantify the relative risk (RR) associated with increased CIT among older donors. METHODS: A retrospective study examining 18,787 liver transplants within the United Network for Organ Sharing database from 2002 to 2006 was performed. Cox Regression analysis was used to model the RR of graft loss with respect to increased CIT among older donors (>60 years) relative to younger donors (<60 years), while controlling for multiple donor and recipient characteristics. RESULTS: Relative to younger donors with minimal CIT (<6 h), a 73.0% increase in the risk of graft loss was observed for older donors with a CIT between 8 and 10 h, a 56.9% increase for CIT between 10 and 12 h, and a 92.7% increase for a CIT of 12 or more hours. Additionally, the RR of graft loss for older donors with minimal CIT (<6 h) was greater than the RR for younger donors with a CIT between 0 and 12 h. CONCLUSION: The additive effects of increased donor age and cold ischemic time greatly impair graft survival. Quantification of the adverse nature of increasing CIT as a potential consequence of wider geographic organ sharing should be considered as allocation policies are modified to improve recipient equity in the face of an aging donor pool. 相似文献
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重视活体肝移植供者的评估和安全 总被引:1,自引:0,他引:1
目前严重影响器官移植临床广泛应用的主要问题之一是可供移植的器官来源严重短缺,由于供移植器官严重短缺,加之外科手术技术的发展,为拯救广大终末期疾病病人,在这种不得已的情况之下,不仅开展了活体肾移植,且开展了活体肺叶、肝脏、胰腺和小肠的移植. 相似文献