移植肾功能延迟恢复原因及防治对策

目的 探讨移植肾功能延迟恢复(DGF)的原因及防治对策.方法 回顾性分析肾移植术后76例DGF的原因、治疗方法及转归.结果 发生DGF的肾前性因素占2.6%,肾性因素占91.9%(其中急性肾小管坏死(ATN)占60.5%,主要由术中术后的低血压及供肾缺血时间延长引起),肾后性因素占5.3%.经血液透析和综合治疗,91%的患者(69例)肾功能恢复正常.结论 肾移植术后ATN是导致DGF的主要原因,合理调整患者术中术后的血压,控制热冷缺血时间是降低DGF的主要措施.     

抗人胸腺细胞兔免疫球蛋白在肾移植免疫诱导治疗中有效性及安全性的Meta分析

<正>肾移植是目前治疗终末期肾脏病最理想的方法,它可以明显提高患者的生存质量[1]。移植术后急性排斥反应(AR)、移植肾功能延迟恢复(DGF)、感染等严重影响人、肾存活率[2,3],因此降低术后AR、感染等发生显得尤为重要。近年已证实应用抗人胸腺细胞兔免疫球蛋白(ATG-F)进行免疫诱导治疗可明显降低肾移植术后AR的发生率[4],但对ATG-F是否增加肺部感染发生率意见不一。为进一步总结、评价ATG-F在肾     

移植肾功能延迟恢复15例的原因分析与治疗

<正>移植肾功能延迟恢复(delayed graft function,DGF)是肾移植术后早期常见的并发症,常导致肾移植术后早期无尿、少尿,增加急性排斥发生率,降低了移植肾长期存活率~([1])。本研究对DGF定义为术后少尿或无尿,在第1周内恢复血液透析,或未恢复血液透析,但术后第7天血清肌酐>400μmol/L。根据文献,DGF多数患者如诊治及时,肾功能可在7~30 d内恢复;但DGF常发生急性肾小管坏死、急     

致敏受者肾移植围手术期处理

目的探讨致敏受者肾移植围手术期处理方法。方法将84例致敏受者和同期108例非致敏受者分为两组,两组患者在年龄、性别、透析时间、HLA匹配、供肾冷热缺血时间等方面无明显差别。致敏组术前诱导治疗,术后预防性抗排斥及加大常规药物用量;非致敏组常规治疗。观察两组患者术后急性排斥(AR)、移植肾功能延迟恢复(DGF)发生情况和人/肾存活,感染及肝肾损害情况。结果术后两组患者在AR、DGF的发生率、人/肾存活上无显著性差异(P>0.05),但致敏受肾组术后感染及肝肾功损害发生率高(P<0.05)。结论致敏受者术前诱导用药、术后预防性抗排斥治疗、加大术后免疫抑制剂用量、对出现并发症的综合处理是致敏受者肾移植成功的关键。     

移植肾功能延迟恢复患者早期应用前列地尔临床观察

目的 评估前列地尔在肾移植术后移植肾功能延迟恢复(DGF)患者早期应用对促进移植肾功能恢复的效果.方法 回顾性分析肾移植术后发生移植肾功能延迟恢复应用前列地尔患者16例,与同期未使用前列地尔的DGF患者14例进行比较,比较两组间术后尿量、血肌酐(SCr)、移植肾血流阻力指数、急性排斥反应的发生率及1年人/肾生存率.结果 应用前列地尔的患者术后尿量明显大于对照组(P ＜0.05);SCr浓度、移植肾血流阻力指数均明显低于对照组(均P ＜0.05);两组急性排斥反应发生率差异无统计学意义(P＞0.05).结论 肾移植受者术后DGF患者早期应用前列地尔有利于促进移植肾功能的恢复.     

40例移植肾穿刺活组织检查的临床分析

目的探讨移植肾穿刺活组织检查对肾移植术后并发症的诊治意义。方法回顾性分析40例接受同种异体肾移植术并于术后进行移植肾穿刺活检患者的临床资料。结果40例患者病理诊断为急性排斥反应共31例,占77.5%;慢性排斥反应5例,占12.5%;其他(包括急性肾小管坏死、肾小管堵塞等)4例,占10%;无超急性排斥反应和加速性排斥反应患者。移植肾组织活检的病理报告与穿刺前临床诊断的符合率在80%以上。结论肾穿刺活组织检查是一种操作简单易行、成功率高、安全性好的诊断方法,对肾移植术后难以根据临床化验资料作出准确判断肾脏损害的并发症及治疗方案的选择有极为重要的指导意义。     

术中平均动脉压对移植肾早期功能的影响

目的探讨肾移植术中移植肾血流开放时,平均动脉压(MAP)对移植肾早期功能的影响。方法947例接受同种异体肾移植术患者,根据移植肾血流开放时的MAP分成A组:MAP<80mm Hg;B组:MAP80~89mmHg;C组:MAP90~99mmHg;D组:MAP100~109mmHg;E组:MAP110~119mmHg;F组:MAP≥120mm Hg。对比观察移植肾功能延迟恢复(DGF)和急性肾小管坏死(ATN)发生率。结果DGF的发生率,A组32.4%,明显高于其他组(P<0.05或P<0.01);ATN的发生率,A组(14.7%)比F组(3.4%)高(P<0.01)。结论移植肾血流开放时的MAP应维持在90mm Hg或以上。     

尸肾移植肾功能延迟恢复15例分析

尸肾移植肾功能延迟恢复(DGF),国外报告发生率较高达10%～60%,一般以术后1周内需要血液透析,但经几天或几周等待后能恢复肾功能者为DGF[1]。本组15例中有3例术后泌尿功能恢复但血肌酐及尿素氮值居高不下,经2～3周后才恢复,故亦列入DGF,但未行血液净化治疗。本文分析本中心6a来(1992年5月至1998年12月)同种异体尸肾移植190例194次尸肾移植发生DGF15例(发生率为7.7%,较国外报告低),发生的原因及治疗、预防措施总结如下。1　资料与方法1.1　临床资料:本组15例DGF中男8例,女7例,年龄20～65岁,其中50岁以上3例。原发病:慢性肾小球肾炎9例,…     

羟乙基淀粉与白蛋白对移植肾功能的影响

目的探讨肾移植术中6％的羟乙基淀粉（HES）与6％HES＋20％白蛋白对移植肾早期功能影响。方法772侧接受同种异体肾移植术患者，根据术中用HES和白蛋白治疗分为两组，A组（n=330）：HES≥500ml；B组（n=442）：20％白蛋白≥100ml＋HES≥100ml。以术后第1天血肌酐值／术前基础值≥75％为移植肾功能延迟恢复（DGF），比较DGF和急性肾小管坏死（ATN）发生率。结果DGF的发生率，A组31．2％，B组26．7％，P〉0．05；ATN的发生率，A组7．6％，B组5．0％，P〉0．05。结论肾移植术中用6％HES与6％HES＋20％白蛋白对移植肾早期功能影响相当。     

小儿DCD供肾移植术后移植肾DGF的观察与护理分析

目的:探讨小儿DCD供肾移植术后移植肾DGF的观察与护理分析。方法:选取2015年1月～2018年1月我院收治的22例肾移植患者作为本次研究对象,采用随机数字表达法分成对照组和研究组,每组11例。给予对照组常规护理,给予研究组个性化护理,对移植肾DGF的情况进行观察。结果:研究组移植肾DGF发生情况和肾功能情况均优于对照组,(P0.05)。结论:患者接受小儿DCD供肾移植术后,给予个性化护理干预,可促进移植肾DGF的患者功能恢复,临床护理效果显著,值得进一步推广应用。     

前列地尔对同种异体肾移植中早期肾功能的保护作用

目的 :探讨前列地尔对肾移植术后早期肾功能恢复的影响。方法 :对85例 (A组 )肾移植受者术中及术后2wk内每天应用前列地尔60μg,与同期276例 (B组)未应用前列地尔的肾移植受者进行对比。结果 :A组术后尿量(6d内)和内生肌酐清除率 (至少7d内 )均明显高于B组 (P<0 01) ,而血肌酐 (5d内)以及血流阻力指数 (14d内 )和肾功能延迟恢复的发生率则明显低于B组(P<0 01) ,但两组急性排斥反应发生率 (3mo内 )无显著性差异 (P>0 05)。结论 :肾移植术中及术后早期应用前列地尔有利于移植肾功能的恢复 ,但不降低急性排斥反应发生率。     

护理干预对移植肾功能延迟恢复的影响

目的研究护理干预对移植肾功能延迟恢复的影响。方法前瞻性分析笔者所在医院2009年1月～2011年9月收治的肾功能延迟恢复的患者,使用焦虑抑郁量表对患者评估,通过心理护理干预,观察患者一般情况、恢复时间及住院时间。结果肾功能延迟恢复患者焦虑及抑郁程度明显大于肾功能正常者,通过心理护理干预,能明显减少患者的焦虑抑郁程度,改善患者的一般情况;但患者肾功能恢复时间和住院时间无明显影响。结论心理护理干预能明显减轻肾功能恢复延迟患者的焦虑与抑郁状况,有利于术后患者的恢复。     

Evidence for a mitochondrial impact of trimetazidine during cold ischemia and reperfusion

In organ transplantation, ischemia-reperfusion injury (IRI) has been implicated in delayed graft function (DGF) as well as in short- and long-term complications. Using an autotransplant pig kidney model, changes in renal function and morphology were determined after different periods of cold ischemia in kidneys preserved in the University of Wisconsin solution (UW), high-Na(+) version of UW (HEH) or Celsior (CEL) a newly developed high-Na(+) solution, with or without trimetazidine (TMZ). Kidney function was better preserved in CEL, UW and particularly HEH in combination with TMZ, particularly after 48 and 72 h. Mitochondria integrity was improved in TMZ-preserved groups. This study indicates that TMZ is efficiently protective against IRI even after prolonged preservation and in different preservation solutions.     

前列地尔在肾移植术后早期应用的临床研究

目的:观察前列地尔在肾移植术后早期的应用对促进移植肾功能恢复的效果。方法:比较93例肾移植受者术后2周内给予前列地尔20μg.d-1(治疗组),同期85例术后未使用前列地尔的肾移植受者(对照组),比较2组术后尿量、血肌酐、彩色多谱勒监测移植肾血流阻力指数、肾功能延迟恢复和急性排斥反应的发生率以及1a人/肾存活率。结果:治疗组术后1d的24h尿量(9.40±1.9)L明显高于对照组(8.11±1.8)L(P<0.01),而术后1d血肌酐、术后5d血流阻力指数、肾功能延迟恢复的发生率((553.4±51.8)μmol·L-1、0.642±0.035、7.53%)则明显低于对照组((624.6±65.2)μmol·L-1、0.689±0.037、14.12%)(P<0.01);2组之间急性排斥反应发生率(9.68%,10.59%)和1a人/肾存活率(98.9%/95.7%,98.8%/95.3%)无明显差异。结论:肾移植受者术后早期应用前列地尔有利于术后移植肾功能的恢复,但对术后急性排斥反应率和1a人/肾存活率的影响不明显。     

Induction antibody therapy in renal transplantation using early steroid withdrawal: long-term results comparing anti-IL2 receptor and anti-thymocyte globulin

Background

The present study intends to investigate the effects of anti-IL2 receptors (anti-IL2R) vs. lymphocyte-depleting agents in the early steroid withdrawal (ESW) scheme.

Methods

This is a retrospective cohort of 167 consecutive adult renal transplant recipients. Immunosuppression was based on tacrolimus and mycophenolate mofetil. Antibody induction therapy was carried out with lymphocyte-depleting agent (thymoglobulin) or anti-IL2R (Basiliximab or Daclizumab). ESW protocol was performed by administering intravenous methlyprednisolone as follows: 500 mg on day 0, 250 mg on day 1, 125 mg on day 2, 60 mg on day 3, and then stopped.

Results

Among the 167 studied patients, 79 (47.3%) received anti-IL2R and 88 (52.7%) received thymoglobulin induction. Significantly fewer episodes of acute rejection were seen at one year in patients treated with thymoglobulin as compared to anti-IL2R (25.6% vs. 11.4%, p = 0.01). At five years, a significant difference in graft survival was observed in anti-IL2R-treated patients compared with thymoglobulin (83.5% vs. 95.5%, p = 0.01). Multivariate analysis disclosed that female sex, antibody induction therapy using thymoglobulin and a trough tacrolimus level higher than 10 were protective factors against acute rejection, while there was a trend to increased risk of acute rejection at first year post-transplantation in patients presenting delayed graft function (DGF). Antibody induction was independently associated with patient and graft survival at five years (OR 0.213, 95% CI 0.046–0.991, p = 0.04).

Conclusion

ESW scheme seems to be safe and its use is beneficial since there are fewer adverse effects. Thymoglobulin induction therapy is associated with fewer rejection episodes. Induction therapy with thymoglobulin is associated with higher patient and allograft survival when comparing with anti-IL2R.     

二重血浆置换及免疫吸附联合IL-2受体单抗方案处理致敏肾移植受者的临床研究

目的:评估应用二重血浆置换(DFPP)、免疫吸附(IA)联合IL-2受体单抗方案处理致敏肾移植受者的临床效果。方法:将56例致敏肾移植受者分为2组,35例试验组应用DFPP、IA联合IL-2受体单抗方案,21例对照组未进行上述处理。采用酶联免疫吸附(ELISA)方法检测肾移植受者体内群体反应性抗体(PRA)水平,比较2组急性排斥反应(AR)和肾功能延迟恢复(DGF)的发生率,随访2组人/肾1a存活率及术后6个月和12个月的血肌酐情况。结果:试验组PRA明显下降,PRA降为阴性者14例;试验组与对照组术后AR发生率分别为28.6%、42.9%(P<0.05),DGF发生率分别为8.6%、14.3%(P>0.05),1a人存活率分别为100.0%、95.2%(P>0.05),移植肾1a存活率分别为94.3%、76.2%(P<0.05),随访6个月/12个月血肌酐分别为(115.2±16.6)/(121.2±28.6)μmol.L-1和(128.4±27.4)/(134.6±33.7)μmol.L-1(P<0.05)。结论:DFPP、IA联合IL-2受体单抗方案可选择性去除受者体内的致敏抗体,可降低致敏受者术后AR的发生率,提高术后肾移植受者1a移植肾存活率,术后6个月和12个月的血肌酐水平也较低。     

Analysis of risk factors and establishment of a risk prediction model for post-transplant diabetes mellitus after kidney transplantation

IntroductionPost-transplant diabetes mellitus (PTDM) is a known side effect in transplant recipients administered immunosuppressant drugs, such as tacrolimus. This study aimed to investigate the risk factors related to PTDM, and establish a risk prediction model for PTDM. In addition, we explored the effect of PTDM on the graft survival rate of kidney transplantation recipients.MethodsPatients with pre-diabetes mellitus before kidney transplant were excluded, and 495 kidney transplant recipients were included in our study, who were assigned to the non-PTDM and PTDM groups. The cumulative incidence was calculated at 3 months, 6 months, 1 year, 2 years, and 3 years post-transplantation. Laboratory tests were performed and the tacrolimus concentration, clinical prognosis, and adverse reactions were analyzed. Furthermore, binary logistic regression analysis was used to identify the independent risk factors of PTDM.ResultsAge ≥ 45 years (adjusted odds ratio [aOR] 2.25, 95% confidence interval [CI] 1.14–3.92; P = 0.015), body mass index (BMI) > 25 kg/m² (aOR 3.12, 95% CI 2.29–5.43, P < 0.001), tacrolimus concentration > 10 ng/mL during the first 3 months post-transplantation (aOR 2.46, 95%CI 1.41–7.38; P < 0.001), transient hyperglycemia (aOR 4.53, 95% CI 1.86–8.03; P < 0.001), delayed graft function (DGF) (aOR 1.31, 95% CI 1.05–2.39; P = 0.019) and acute rejection (aOR 2.16, 95% CI 1.79–4.69; P = 0.005) were identified as independent risk factors of PTDM. The PTDM risk prediction model was developed by including the above six risk factors, and the area under the receiver operating characteristic curve was 0.916 (95% CI 0.862–0.954, P < 0.001). Furthermore, the cumulative graft survival rate was significantly higher in the non- PTDM group than in the PTDM group.ConclusionsRisk factors related to PTDM were age ≥ 45 years, BMI > 25 kg/m², tacrolimus concentration > 10 ng/mL during the first 3 months post-transplantation, transient hyperglycemia, DGF and acute rejection.