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目的 了解尸肾移植受者和亲属活体肾移植受者术后焦虑抑郁状况.方法 采用Zung焦虑自评量表(SAS)和抑郁自评量表(SDS)对71例尸肾移植受者(尸肾组)和74例亲属活体肾移植受者(活体组),于移植术后第3个月进行问卷调查.结果 两组SAS、SDS评分显著高于常模(均P<0.01);活体组SAS评分显著高于尸肾组(P<0.01).活体组焦虑、抑郁阳性率显著高于尸肾组(均P<0.05).结论 肾移植受者术后焦虑抑郁普遍存在.亲属活体肾移植受者术后焦虑抑郁较尸肾移植受者更严重. 相似文献
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目的了解尸肾移植受者和亲属活体肾移植受者术后焦虑抑郁状况。方法采用Zung焦虑自评量表(SAS)和抑郁自评量表(SDS)对71例尸肾移植受者(尸肾组)和74例亲属活体肾移植受者(活体组),于移植术后第3个月进行问卷调查。结果两组SAS、SDS评分显著高于常模(均P〈0.01);活体组SAS评分显著高于尸肾组(P〈0.01)。活体组焦虑、抑郁阳性率显著高于尸肾组(均P〈0.05)。结论肾移植受者术后焦虑抑郁普遍存在。亲属活体肾移植受者术后焦虑抑郁较尸肾移植受者更严重。 相似文献
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由于尸体肾源严重不足,许多终末期肾病患者得不到很好的治疗.在这种情况下,许多国家逐渐开展了活体供肾移植,以解决肾源不足问题.美国器官移植网数据显示:2004年美国肾移植量约16000例[1],其中6647例是活体供肾移植[2],大约为41.5%.巴西器官联合组织的数据显示:巴西2002和2003年活体供肾移植占60%,004年占48%.许多研究对活体供肾切取术及供者术后的安全性进行了论证,表明供肾的切取是安全的,致病和致死率低[3].目前开展活体供肾移植较多的国家开始重视供者的心理状况及术后的生命质量. 相似文献
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目的探讨活体肾移植手术中护理配合的注意事项及体会。方法对23例活体亲属肾移植手术的护理配合进行分析,总结活体肾移植手术中护理配合的注意事项。结果术前充分准备,术中按程序施术,加之术中密切护理配合,23例活体亲属肾移植手术全部成功且近期疗效很好。结论术前的充分准备,正确的手术操作及术中的密切护理配合,是保证肾移植成功的重要环节。 相似文献
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目的 比较亲属肾移植和非活体肾移植术后患者群体反应性抗体(PRA)产生的频率,为预测移植肾长期存活提供参考资料.方法 回顾性分析2003年12月一2007年9月48例术后亲属肾移植患者和258例2003年2月-2007年6月术后非活体肾移植PRA.此两组肾移植患者肾移植前PRA均阴性.PRA检测采用美国莱姆德公司抗原筛选板和美国GTI公司提供的ELISA筛选HLA-Ⅰ类、Ⅱ类混合抗原板.结果 48例亲属肾移植中仅有4例为PRA阳性,占8.33%.258例尸体肾移植中PRA阳性患者有62例,占24.03%,两者之间差异有统计学意义(P<0.05).亲属肾移植男性患者35例,抗体阳性3例,占8.57%.非活体肾移植男性患者152例,抗体阳性患者35例,占23.03%,两者之间具有显著性差异(P<0.05).亲属肾移植女性患者13例,仅1例出现抗HLA-Ⅱ类抗体.非活体肾移植女性患者106例,抗体阳性患者20例,占18.87%,两者之间具有显著性差异(P<0.05).结论 非活体肾移植患者术后产生的抗HLA-抗体的机率高于亲属肾移植患者. 相似文献
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目的 探讨活体亲属供肾移植及术前特异性输供体血的安全性及可行性,并评价其临床效果。方法 总结5例活体亲属供肾移植的临床效果和供肾者术后的恢复情况。结果 5例活体亲属供肾者经随访10~24月全部健康,正常工作,术后无明显的并发症,5例肾移植受者目前移植肾功能(血肌酐及内生肌酐清除率)均正常,且已恢复正常的学习和工作,术后的免疫抑制剂使用量较同期的尸体肾移植受者低10%~15%。结论 活体亲属供肾是扩大供肾来源的较好途径,移植术后人/肾存活率优于尸体肾移植人/肾存活率。术前特异性输供体血有利于诱导受者产生免疫耐受。 相似文献
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Rh阳性患者接受Rh阴性亲属活体供肾移植(附2例报告及文献复习) 总被引:1,自引:0,他引:1
目的:探讨Rh阳性患者接受Rh阴性亲属活体供肾移植的安全性.方法:报告我院近期成功完成的2例Rh阳性患者接受Rh阴性亲属活体供肾移植病例,结合文献进行分析.结果:2例肾移植手术过程顺利,开放肾血流后即有尿液泌出,手术当日即进入多尿期,术后第3天血肌酐正常.住院期间无超急性、加速性、急排斥反应和溶血现象发生.两例术后分别住院36、34天后顺利出院.结论:通过免疫抑制治疗的加强和器官的充分灌洗,Rh阳性患者接受Rh阴性亲属活体供肾移植是安全的. 相似文献
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亲属活体供肾移植治疗Alport综合征(附1例报道并文献复习) 总被引:2,自引:0,他引:2
目的:探讨亲属活体供肾移植治疗Alport综合征(AS)的安全性和治疗特点。方法:2004年7月为1例Alport综合征患者施行亲属活体供肾移植手术,术后对供、受者均随访1年7个月,分析亲属供肾移植治疗AS的特点以及评价活体供肾的安全性。结果:供者各项生命指标良好,肝肾功能无明显变化;受者术后肾功能恢复理想,随访期间未见AS复发及其他脏器功能的继续损害。结论:Alport综合征是一种临床上较少见的遗传性疾病。亲属活体供肾移植治疗AS是一种可供移植医生考虑的治疗手段,对于是否存在术后的AS复发尚有待更长期的临床观察。 相似文献
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Schulz T Schenker P Flecken M Schäffer M Viebahn R Kapischke M 《Zentralblatt für Chirurgie》2005,130(2):132-136
Simultaneous pancreas kidney transplantation (SPK) is an established therapy for type 1 diabetics with end stage or preterminal renal disease. SPK is superior to isolated kidney transplantation (KTX) in diabetic patients. Even pancreas-re-transplantations are more common in these patients now, mostly after SPK. But Experience with SPK after KTX is rare. Between 1994 and 2003 six Re-SPK 4.5 to 8.5 years after KTX were performed in our department. Average age of the recipients was 40.5 years. They had been suffering from diabetes for an average of 29.3 years. Four recipients were on dialysis again, whereas two had preterminal renal insufficiency. Pancreas transplants were drained through the bladder (n = 1) or into the small intestine (n = 5) with systemic venous anastomosis. After a median observation period of 28 months (8 to 99 months) all six recipients are insulin free. One patient lost his kidney graft due to severe acute rejection. Therefore kidney graft survival is 83 %. Four acute rejections (66 %) were observed in 4 patients. Only one rejection was treated successfully by steroids. Two rejections could be stopped with antibodies. 3 patients had infections in the early postoperative period (sinusitis, urinary tract infection, wound infection). Even after KTX with graft failure, diabetic patients suffering from renal disease can be re-transplanted successfully with SPK. 相似文献
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Despite decades of experience with child bearing in women with kidney transplants, these pregnancies remain high risk with an increased prevalence of hypertension and pre-eclampsia. Infertility, common in women with end-stage renal disease, is rapidly restored after transplant although pregnancy rates appear lower in transplant recipients than the general public. Many unanswered questions exist, some old questions such as what is the optimal timing of pregnancy after transplant, whether breast feeding is safe, the long-term impact if any on the offspring, and whether pregnancy negatively affects the kidney graft; and some new questions such as whether to modify immunosuppression in a patient taking a mycophenolic acid-containing drug, whether kidney donation has a deleterious impact on future pregnancies, whether to use erythropoietin-stimulating agents, and the role of BK virus. Counseling about contraception and pregnancy after transplant should be initiated during the pretransplant evaluation process. It is important because of the rapid restoration of fertility that occurs after transplant as well as the many risks and unanswered questions that remain. 相似文献
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The authors report fourteen cases of lymphocele in a series of one thousand consecutive renal transplantations (1.4%). The prevention of these lymphoceles depends on rigorous lymphostasis. The diagnosis is based on ultrasonography. The treatment indicated in cases of voluminous lymphoceles consisted in marsupialization and omentoplasty. 相似文献
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J J Curtis 《American journal of kidney diseases》1986,7(3):181-196
Patients with kidney transplants are often hypertensive. Investigators have described the characteristics of this hypertension in man. Moreover, the hypertension of kidney transplant patients has a higher probability of being responsive to surgical intervention than does hypertension in the general population. Yet the mechanisms of the many varieties of posttransplantation hypertension are not known in detail. Detailed studies that would best be done in animal models are rare. Both medical and surgical management of this transplantation-associated complication needs further study. 相似文献
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肾移植是终末期肾病患者的最佳治疗方案,但移植肾远期存活仍是临床上面临的重要难题。肾缺血-再灌注损伤(IRI)和移植肾排斥反应被认为是影响移植肾远期存活的重要因素,受固有免疫和适应性免疫细胞调控。巨噬细胞是固有免疫细胞中一种,可协助启动适应性免疫,分为M1型巨噬细胞、M2型巨噬细胞和调节性巨噬细胞。先前研究揭示M1型巨噬细胞加重肾IRI和急性T细胞介导的排斥反应(TCMR);而M2型巨噬细胞减轻肾IRI和急性TCMR,但与抗体介导的排斥反应(AMR)呈正相关;调节性巨噬细胞是巨噬细胞一种特殊亚群,可诱导移植免疫耐受,具有极大临床应用前景和基础科研价值。本文述评了巨噬细胞分型、巨噬细胞与肾IRI、移植肾排斥反应及调节性巨噬细胞与免疫耐受的关系,并分析了其可能作用机制,以期诱导巨噬细胞亚型改变或清除特定亚型巨噬细胞,进而改善移植预后及移植肾远期存活。 相似文献
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During the first Yemeni Congress of Uro-Nephrology in Aden, an international team performed the first kidney tranplantations in the region. We report the difficulties encountered and discuss the pros and cons for transplantations in developing countries. 相似文献
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Owing to the shortage of deceased donors in Japan, since 1989, we have performed ABO-incompatible kidney transplantation (ABO-IKTx) to expand the indication for living donor kidney transplantation. During the past two decades, about 2000 ABO-IKTxs were performed. Since 2001 the success rate for these kidney transplants has reached 96% for 1-year, 91% for 5-year and 83% for 9-year graft survival, similar to outcomes of ABO-compatible kidney transplantation (ABO-CKTx). This dramatic improvement in results means that ABO-IKTx has become accepted as a therapeutic alternative for end-stage renal failure. Today ABO-IKTx accounts for approximately 30% of all living donor kidney transplantations performed in Japan.We have been making a lot of efforts to elucidate the mechanism of acute antibody-mediated rejection in ABOI-KTx in order to overcome the ABO barrier and to improve the outcome. From careful and precise clinical observations, proteomic analysis of ABO histo-blood group antigens in graft endothelial cells and deep insight into immunology and biology, we have reached the hypothesis that the structural difference of ABO histo-blood group antigens and de novo corresponding antibody production would be the key and keyhole of the development of acute AMR in ABOI-KTx. Preoperative desensitization therapy would be the best solution for the suppression of acute AMR and graft loss, which is now widespread and improves the outcome. 相似文献