亲属活体供肾移植供受者的临床护理

目的 探讨亲属活体供肾移植的临床护理要点.方法 分析我院14例亲属活体肾移植的临床资料,总结供受者手术前、后的护理要点及并发症的预防、处理及护理措施.结果 通过供者的心理护理、肾动脉造影后护理、供肾后护理,14例供者术后10天安全出院,无并发症发生;通过受者的一般护理、肾功能监测、心理护理及健康指导,所有患者无外科并发症.12例术后3天肾功能正常,其中1例术后发生急性排斥反应,经抗淋巴球蛋白冲击治疗逆转.2例肾功能延迟恢复,分别于术后1周及3周肾功能恢复正常.结论 加强对供受者手术后的护理,能有效确保供受者的安全,减少手术并发症的发生.     

活体亲属供肾移植12例

目的 总结亲属活体肾移植的临床应用经验.方法 回顾分析12例亲属活体肾移植其临床资料.结果 供者无外科并发症发生,恢复良好.12例受者中,1例高致敏受者(群体反应性抗体,PRA 100%)成功接受移植.1例发生急性排斥1次,逆转治疗后肾功能良好.1例由于擅自停用免疫抑制剂量而于移植后1年移植肾失功,余11例肾功能一直良好.结论 亲属活体供肾移植效果好,安全可行.     

亲属活体供肾移植52例供受者健康教育的实践

目的：对亲属活体供肾移植供受者提供有效的健康指导,改善患者的生活质量,延长移植肾的存活期。方法：设立1名专职护士,运用多层次,个体化的教育方法,对52例亲属活体供肾移植供受者健康指导。结果：随访9-53个月,52例亲属活体供肾移植供受者有良好的依从性,生活自理,至今肾功能基本正常。结论：对亲属活体供肾移植术后供受者进行多层次、个体化的健康教育,重视供者的长期随访,培养受者良好的依从性,是供受者长期生存的必需,也是医务工作者的责任。     

夫妻活体供肾移植1例报道

我院自2002年2月至今共完成活体亲属供肾移植12例，其中夫妻间活体供肾移植1例，特报道如下。     

活体亲属供肾移植19例报告

目的：对亲属活体供肾的优点和临床意义进行探讨。方法：总结19例亲属活体供肾肾移植临床资料。其中,男性受体11例,女性受体8例,年龄20 ～50岁,平均28.6岁;男性供体10例,女性供体9例,年龄38 ～62岁,平均52.8岁。结果：19例中有16例术后2 ～5d肾功能恢复正常,另外3例中,其中1例术后1周出现急性排斥反应,经抗排斥治疗,3周后移植肾功能恢复正常。1例术后2个月发现移植肾输尿管膀胱吻合口狭窄,行输尿管再植后肾功能恢复,1例术后出现肾功能恢复延迟。结论：术前全面地对供受者进行全面的体检和化验是亲属活体肾移植术后成功的保证。亲属肾移植的组织配型好,供肾缺血时间短,排斥反应发生少,免疫抑制剂用量少,移植效果优于尸肾移植,且能缓解肾源短缺。     

活体亲属供肾移植供者的护理

本科于２０００年１２月～２００１年６月间共实施活体亲属供肾移植１１例，通过对１１名供者的治疗和护理，供者均顺利康复，取得了良好的效果。现将护理体会总结如下。１临床资料活体供肾移植１１例。供者１１名，男５名，女６名，年龄４７～５８岁。其中父亲供给儿子５例，母亲供给女儿１例，母亲供给儿子４例，姐姐供给弟弟１例。全部供者均为自愿捐献。供者均健康，各项化验检查指标均正常，无手术禁忌证。手术前通过数字减影血管造影（DSA）或磁共振成像（MRI）检查确定供肾血管解剖。取肾手术均采用腰部第１１肋间切口。肾脏的热…     

亲属活体供肾肾移植成功1例

2000年5月,我院成功地进行亲属活体供肾肾移植1例,现作报道. 1 临床资料 1.1 一般资料受者男,29岁,已婚.原发病为慢性肾小球肾炎,持续不卧床腹膜透析(CAPD)4个月,HBV抗原、抗体均为阴性,HCV抗体阴性.供者为受者胞兄,男,33岁,未婚.术前检查均正常.肾动脉造影提示双侧肾动脉均为单根.HBV抗原、抗体均为阴性,HCV抗体阴性.供、受者ABO血型均为A型,淋巴细胞毒交叉试验为1%.     

亲属活体供肾移植2例报告

我院于 2 0 0 0年 4～ 5月分别对 2例尿毒症患者施行亲属活体供肾移植 ,两名受者术后 3d内肾功能恢复正常 ,无急性排斥反应发生 ,随访 6个月 ,肾功能未见减退。取得满意疗效 ,现报告如下。1　资料与方法1.1　一般资料例 1,男性 ,43岁。原发疾病为慢性肾小球肾炎。供者为其同母异父的兄长 ,5 1岁。二人血型均为“O”型。淋巴细胞毒交叉配合试验为 0 .0 1,PRA为 0 .0 5 ,HL A- A2位点相同 ;HL A-A33(19)位点供者缺少 ,HL A - B5 1(5 )位点相同 ;HL A- B5 8(17)位点错配 ;HL A- Bw4位点相同 ;HL A- Bw6受者缺少 ;HL A- DR、HL A…     

活体亲属供肾移植临床分析

器官来源的缺乏正制约着器官移植的广泛开展。为扩大供肾来源，我院自1983年起开始进行活体亲属供肾移植，至今共完成12例，现介绍如下。     

亲属活体供肾肾移植的临床研究

目的探讨亲属活体供肾肾移植的临床效果和安全性。方法回顾性分析15例亲属活体供肾肾移植患者的临床资料。结果 15例供、受者均健康存活,供肾切取手术均成功,受者肾功能于术后3～7 d恢复正常;术后发生急性排斥反应1例,发生淋巴漏1例,发生肺部感染1例,均治愈。结论亲属活体供肾肾移植可获得满意的效果,具有良好的临床安全性。     

核素肾动态显像在肾移植亲属供肾功能评估中的作用

目的分析核素肾动态显像在评估活体供肾者肾功能状况中的作用。方法 140例亲属供肾者术前均接受碍标记二乙三胺五乙酸(99Tcm-DTPA)肾动态显像,计算出总肾和分肾肾小球滤过率(GFR)值;根据肾功能图形和GFR值评估供肾功能。结果发现17例肾功能异常,主要表现为排泄缓慢、半排时间延长或GFR值降低。其中3例双肾功能损害,5例右侧单肾功能损害,9例左侧单肾功能损害。结论肾动态显像可用于评估亲属活体供肾者的总肾和分肾功能,有助于筛选供肾和预测移植术后肾功能的状况。     

大于50岁亲属活体供肾移植效果分析

目的探讨50岁亲属活体供肾移植的移植效果。方法 1993年4月～2007年12月施行亲属活体供肾移植107例,按照供者年龄分为两组,其中50岁为研究组,45例,≤50岁为对照组,62例。随访时间12～180个月,平均49个月。比较两组受者术后肾功能恢复情况、并发症及近、远期移植肾功能、人/肾存活率等。结果移植手术均获成功。两组受者在年龄、术前透析时间、配型、肾缺血时间、抗排斥方案应用等方面比较显示均衡性良好,术后1周、1月、1年、3年Scr水平及1、3、5、8年人/肾存活率组间比较差异均无统计学意义(P0.05)。结论供者年龄50岁亲属活体供肾移植效果,满意年龄非亲属活体供肾绝对禁忌症。     

Multidetector row-CT in evaluation of living renal donors

Background Multidetector-row CT （MDCT） has been evolving to the standard evaluating method of potential living donor in most centers, and can provide excellent details for selecting candidates and determining surgical technique.This study aimed to assess the value of MDCT in evaluation of the anatomy of living kidney donors and to reveal the prevalence of renal vascular variations in a Chinese population.Methods One hundred and four potential donors underwent MDCT and the data sets were post-processed for reformatted images with various techniques, such as maximum intensity projection （MIP）, a volume-rendering technique （VR）, and multiplanar reformation （MPR）. Donor nephrectomies were performed on 97 candidates after MDCT evaluation with the findings during surgery constituting the standard of reference. Resulting MDCT images were compared with actual anatomy found during surgery. Results The MDCT images accurately displayed the anatomic structure of the main renal arteries and veins as well as the upper ureters, except in one case with horseshoe kidney. The prevalence of accessory arteries revealed in images was 27.2% （28/103） and early branching was found in 12.6% （13/103）. Compared with findings during surgery, the detection of accessory arteries in MDCT images was 85.7% （6/7）, and the detection of larger accessory arteries （〉1.5 mm in diameter） was 100%. Detection of early branching was 100%.Conclusion MDCT helps accurately evaluate the renal anatomy of potential donors thus facilitating the planning of surgery.     

MSCTA在活体肾移植供肾切除术前的应用

目的  探讨多层螺旋CT血管成像（MSCTA）在活体肾移植供肾切除术前的应用价值。方法  采用西门子公司双源CT设备对40例受检者行MSCTA检查,评估肾脏血管解剖及变异情况。结果  40例80个肾脏中,MSCTA显示64个肾脏由单支动脉供血、67个肾脏由单支静脉引流、16个肾脏存在副肾动脉、11支主肾动脉存在过早分支、1例左肾上段动脉起始部局限性狭窄、1例肠系膜上动脉起始部局限性狭窄、1例左肾静脉中段见一血管袢。40例受检者中22例行供肾摘除术,术中所见供肾血管情况与MSCTA术前评估结果一致。结论  MSCTA可准确显示受检者肾脏血管情况,可作为活体肾移植供肾术前血管评估的首选检查方法。     

微嵌合体在母亲子女之间活体肾移植中的作用

目的 观察不同供受体关系亲属活体肾移植的临床疗效及其与微嵌合体之间的关系.方法 回顾性分析复旦大学附属中山医院2004-2008年130例亲属肾移植临床资料.受者随访1～5年,利用微卫星及性染色体决定基因聚合酶链反应(PCR)技术检测外周血DNA微嵌合体,并根据随访结果,分析微嵌合体的作用.结果 受者1-年人/肾存活率分别为93.8%和92.3%,各供受者组关系比较发现1-年人/肾存活率差异均无统计学意义(均P＞0.05).130例受者中46例(35.4%)行移植肾穿刺活检,病理结果证实发生急性排斥反应26例,急性排斥反应发生率为20.0%(26/130).26例中14例(53.8%)为母亲子女之间肾移植,12例(46.2%)为其他供受者关系肾移植.母亲子女肾移植中急排斥反应发生率为30.4%(14/46),高于其他供受者关系肾移植急性排斥反应发生率(14.3%,12/84,P=0.028).130例受者中43例术后不同时间进行了外周血微嵌合体检测,在其中16例母亲供肾的受者中,4例检测到微嵌合体,阳性率25.0%;27例其他供者的受者中,4例检测到微嵌合体,阳性率为14.8%;母亲供肾微嵌合体阳性率比其他关系高约1倍.微嵌合体阳性组急性排斥反应发生率较微嵌合体阴性组高约1倍.结论 母亲子女之间肾移植急性排斥发生率较高;母亲供肾的微嵌合率较高;微嵌合率高的组别急性排斥反应较高;母亲子女之间特殊的免疫学关系可能影响肾移植效果.

Abstract：

Objective To compare the microchimeric and rejection rates in living donor kidney transplant recipients in mother and child relations and other relations. Methods This retrospective singlecenter study enrolled 130 recipients to receive allografts from living related donors from 2004 to 2008 at our hospital. They were followed up for 1 - 5 years. The demographic data of the study population were analyzed by basic statistical methods. A total of 43 recipient blood samples were collected for the detection of microchimerism by the assays of short tandem repeat (STR) and sex-determining region-y gene (SRY)polymerase chain reaction (PCR). Results The 1-year patient/graft survival rates were 93.8% and 92.3% respectively. And there was no significant differences between mother and child group and other relative group. Forty-six biopsy samples were collected from 46 recipients. Twenty-six (20.0% ) cases had the occurrences of acute rejection episodes in different Banff degrees as proven by biopsy. 53. 8% ( 14/26)cases were mother and child renal transplantation, higher than other relative (46. 2%, 12/26) . The mother donor kidney transplant recipients had about a twice higher rejection rate ( 30.4% vs 14. 3%, P = 0.028 ) and a twice higher microchimeric rate(25. 0% vs 14. 8% )than other relative. Conclusion Compared with other relations, the mother donor kidney recipients tend to have higher rates of microchimerism and acute rejection. And the special immune effect in mothers and children renal transplantation may influence its outcomes.     

多层螺旋CT在活体肾移植术前评估中的综合应用

目的：评价多层螺旋CT血管成像及后处理技术在活体肾移植术前评估中的综合应用价值。方法：选取2007年10月～2008年3月活体肾移植供体32例,术前行多层螺旋CT血管成像,使用MIP、VR、MPR和CPR等后处理技术进行图像后处理,评估供肾血管、集尿系统及。肾实质状况,并与手术结果相对照。结朵：32例供体CT血管成像原始数据经后处理均获得满意图像,所有供肾形态、位置正常,双侧肾动、静脉主干及分支、集尿系统显影清晰。后处理图像还能清楚显示供肾与周围毗邻组织的立体关系。所有供肾CT血管成像所见与手术结果完全吻合。结论：多层螺旋CT血管成像及后处理技术能准确显示供肾形态特征、血管解剖及变异,可做为活体肾移植术前检查的首选检查方法。     

Use of non-heart-beating donors in renal transplantation

The rate of renal transplantation has plateaued and is now limited by the number of donor organs available. In the past all donor kidneys came from living donors or controlled non-heart beating donors. It was not until the introduction of brainstem death criteria that cadaveric heart beating donors became the main source. Recently, there has been renewed interest in non-heart beating donors, who have already suffered cardiorespiratory arrest. Kidneys from these donors have a unique set of problems associated with increased duration of warm ischaemia. To minimise this, the kidneys are cooled in situ using an intra-aortic balloon catheter and are perfused with cold hyperosmolar citrate. Retrieval can then proceed in the normal fashion. Despite a higher level of delayed graft function, the results from non-heart beating renal transplantation are good, with long term function comparable to cadaveric organs. If used safely, they enable significant expansion of the donor pool. Techniques in the future, such as machine perfusion preservation, may further improve the results from non-heart beating programmes.     

Renal function of donors and recipients after living donor kidney transplantation in a Chinese cohort

Background  Living donor kidney transplantation (LKT) has been booming in China. This study aimed to elucidate the renal function of both Chinese donors and recipients after the donation and transplantation.

Methods  One hundred and forty-one pairs of donors and recipients for LKT were randomly selected and followed up for up to seven years. The donors’ and recipients’ renal function was recorded before and after operation.

Results  The donors presented a mean age of (43.9±7.5) years at donation. The female contributed 101/141 (71.6%) in all donors, and no effect was shown between genders on healthy donors’ renal function. The donors’ glomerular filtration rates (GFR) were (119.5±20.4) ml/min, (85.2±17.6) ml/min, (87.2±15.9) ml/min, (82.1±14.6) ml/min and (83.0±13.7) ml/min preoperatively, and for five days, three months, one year and beyond one year after the operation. The donors for the period of 1–3 years, 3–5 years and more than 5 years after donation showed GFR as (83.9±12.7) ml/min, (83.0±17.6) ml/min, and (80.9±20.8) ml/min, respectively, no statistically significant difference was found. Moreover, no significant clinical changes in blood pressure and proteinuria were found among the donors. In the recipients, delayed graft function (DGF) rate was 6.4%, acute rejection rate was 11.3%, and GFR were (66.5±16.4) ml/min, (73.2±19.6) ml/min and (63.9±18.6) ml/min respectively at three months, one year and beyond one year post-transplantation respectively.

Conclusion  The donors/recipients of LKT in Chinese population experience well-functioning remaining/donor kidneys.

     

双源CT血管成像对活体肾移植供体肾脏血管的评价

目的 评价双源CT肾血管成像在活体肾移植供体肾血管解剖的价值.方法 82例活体肾移植供体行双源CT三维肾血管检查,采用多平面重建和容积重建技术原始图像评估肾脏血管情况.结果 82例活体肾移植供体获得满意的血管成像图像.单侧或双侧肾血管变异的供体37例(45.1％,37/82),其余45例(54.9％,45/82)双...     

60岁以上供肾亲属肾移植临床疗效分析

 目的 总结单中心供体年龄超过60岁亲属肾移植的临床经验。方法 回顾性分析复旦大学附属中山医院肾移植中心2004年至2008年供体年龄超过60岁供肾肾移植病例15例,其中母亲作为供体7例,父亲作为供体7例,丈夫作为供体1例。采用回顾性方法及基本统计方法进行分析。结果 供体9例采用手助腹腔镜手术方式取肾（60%）,6例采用小切口开放方式（40%）,左肾作为供肾13例（86.7%）,右肾2例（13.3%）。受体12例肌酐平均3.5 d降至正常水平。供受体均随访1～4年,供体3例肾功能异常,受体死亡1例（移植肾血栓形成）,介入B超穿刺9例,病理结果示细胞排斥6例（40%）;细胞毒性损伤2例（13.3%）;1例细胞排斥证据不足。7例受体肾功能异常（46.7%）,均为男性。结论 60以上老年供体肾移植排斥发生率较高,且供肾肾单位多数不能满足男性受体代谢需要。