亲属活体供肾移植

本文就亲属活体供肾移植的免疫学基础及临床现状等进行了简要综述。     

活体亲属肾移植19例报告

目的探讨活体亲属肾移植的临床应用价值。方法回顾性分析我院2002年2月～2006年5月完成的19例活体亲属肾移植的临床效果。结果19例供者术中均未输血，术后未发生严重的并发症，于术后7～10天出院。术后随访1～51个月，平均28个月，复查肝、肾功能均正常。19例受者术后随访1～51个月，平均28个月，其中16例术后3～5天肾功能恢复正常，3例于术后3周内肾功能恢复正常。2例发生急性排斥反应，其中1例经激素冲击治疗后逆转，另1例激素治疗无效，改用抗人血淋巴细胞球蛋白治疗10天后逆转。1例为同卵双生兄弟之间肾移植，术后仅用激素治疗3周，未用其他免疫抑制剂，未发生急性排斥反应。2例术后情况良好，半年后自行减量乃至停用免疫抑制剂，导致急性排斥反应，经激素冲击治疗后好转。1年人／肾存活率为100％。结论活体亲属肾移植安全可行；受者人／肾存活率高。     

亲属活体供肾移植现状

肾移植已成为治疗终末期肾脏疾病的主要手段,肾源缺乏成为限制发展的主要因素,亲属活体供肾移植是一条扩大供肾来源的较好途径,其安全性及良好的效果已得到证实.本文综述了亲属活体供肾移植的现状及进展.     

亲属活体肾移植19例报告

目的总结分析活体亲属供肾移植的围手术期的管理、手术和治疗经验,探讨其临床效果。方法回顾性分析19例亲属活体供肾移植的临床资料,包括术前检查、手术方法和创新、免疫抑制的用药方案及临床观察。结果供肾均为左肾,经腹手术,手术顺利,移植肾在开放血液循环后1～10min内分泌尿液,供体肾功能在1周内恢复正常,未出现严重并发症,全部受者存活至今,肾功能良好。结论亲属活体供肾移植的移植效果明显优于尸体供肾移植,排斥反应发生率低,恢复顺利。     

老年活体亲属供肾移植的安全性分析

目的 探讨老年活体亲属供肾移植供体、受体的围手术期并发症、疗效及安全性.方法 亲属活体供肾移植132例,分为老年供体组(≥55岁,43例)和中青年供体组(＜55岁,89例);对供受体的住院时间、手术前后血肌酐(SCr)、内生肌酐清除率(CCr)、肾小球滤过率(GFR)、并发症以及受体的急性排斥反应率、人/肾存活率等进行比较分析.结果 2组供者术前SCr分别为(77.67±15.21)、(83.09±15.98)μmol/L,术后7 d分别为(109.54±22.32)、(106.56±23.46)μmol/L,均在正常范围内,2组间各时间点比较差异均无统计学意义(P值均＞0.05).术后3个月2组供者SCr分别为(112.57±20.87)、(104.29±19.43)μmol/L,与术前比较分别上升44.93%和25.51%,老年供体组比中青年供体组供者scr升高更明显.差异有统计学意义(P=0.0268).2组术前CCr分别为(1.63±0.34)、(1.56±0.25)ml/s,术后10 d分别为(0.83±0.29)、(1.11±0.27)ml/s.老年供体组术后3个月CCr为(0.97±0.10)ml/s,中青年供体组为(1.16±0.17)ml/s.2组手术前后CCr变化差异无统计学意义(P＞0.05).老年供体组术后10 d的留存肾GFR为(36.58±13.26)ml/min,术后3个月增加至(52.31±12.74)ml/min,达到原双肾GFR[(73.01±20.96)ml/min]的71.65%.中青年供体组术后10 d GFR为(38.32±10.79)ml/min,术后3个月增至(56.31±12.95)m1/min,达到原双肾GFR[(78.34±20.98)ml/min]的71.88%.手术前后GFR变化差异均无统计学意义,P值均＞0.05.供者手术并发症包括术中脾脏包膜下血肿1例、降结肠破裂1例和切口脂肪液化5例.术前和术后各时间点2组受者SCr水平差异无统计学意义(P值均＞0.05).2组供者平均住院时间分别为(13.2±3.4)和(12.8±2.6)d,P=0.4563.2组受者平均住院时间分别为(23.1±11.9)和(22.3士11.4)d,P=0.6991.老年供体组受者6个月内急性排斥反应发生率为4.7%(2/43),中青年供体组为7.9%(7/89).术后1年内2组各死亡1例,中青年供体组因急性排斥反应移植肾失功1例.结论 老年活体亲属供肾可能存在一定危险性,应予以重视,但供体年龄并非独立风险因素.在严格控制老年供者的纳入标准、对供者进行全面系统评估的情况下,老年供体活体肾移植的供体和受体围手术期并发症/疗效及安全性与中青年供体比较无明显差异.     

亲属活体供肾肾移植7例报告

目的：总结和分析亲属活体供肾肾移植的手术经验。方法：回顾性分析７例亲属活体供肾肾移植的临床资料,均按常规作肾移植术。结果：７例供肾者均顺利渡过围手术期;７例受者仅１例有排斥反应,６例无排斥反应。随访４～１１个月,除１例术前ＨＢｓＡｇ阳性者术后６个月因肝功能损害而死亡外,其余６例至今肾功能良好。结论：亲属活体供肾肾移植的最大好处是排斥反应,可有一个更长的移植肾成活时间,摘取供肾手术应更加仔细。     

亲属活体肾移植供者的安全性分析

目的 分析亲属活体肾移植供者手术前后的相关指标变化,探讨活体供者的安全性.方法对132例亲属活体供肾者进行心理和生理分析,包括尿常规、血生化、肾小球滤过率(GFR)、内生肌酐清除率(CCr)和生活质量等指标.结果 132例供肾者的生活质量评分与正常人群比较差异无统计学意义(P＞0.05).供肾切取术前供者血肌酐(SCr)为(78.33±15.94)μmol/L,术后7 d为(108.49±19.88)μmol/L(P=0.000);术后6个月为(112.47±20.38)μmol/L,与术后7 d比较差异无统计学意义(P=0.109).供肾切取术前供者CCr为(95.80±20.92)ml/min,术后7 d为(57.36±14.92)ml/min,与术前比较P=0.017;术后6个月为(65.49±8.25)ml/min,与术后7 d比较差异无统计学意义(P=0.619).术前双肾GFR为(74.08±18.51)ml/min,右肾GFR为(38.43±10.33)ml/min,供肾切取术后6个月保留右肾GFR为(56.49±13.01)ml/min,与术前双肾GFR比较,P=0.000;保留右肾GFR与术前自身比较代偿性增加47.0%.手术并发症包括脾脏包膜下出血1例,降结肠破裂1例,切口脂肪液化5例. 结论 术前对供肾者进行充分系统的医学心理学和生理学评估,严格履行风险告知义务,供受者术中规范操作,围手术期合理管理和建立严密的随访制度,可以有效提高亲属活体移植供肾者的心理和生理安全性.     

活体亲属供肾移植五例报告

1999年5月至11月,我院为5例尿毒症患者施行了活体亲属供肾移植。供、受者手术顺利,术后恢复良好,现报告如下。一、临床资料5例受者均为男性,年龄21～31岁,原发病均为慢性肾小球肾炎。5例均采用血液透析,透析次数10～41次,平均28.6次。5名供者,4例为亲母,1例为亲父,年龄45～52岁,平素身体健康,无肝炎、肺结核、肾脏及心脏疾病、高血压、糖尿病等病史。术前均作肾脏彩色超声波、排泄性尿路造影、选择性腹主动脉及肾动脉造影,行三大常规、肝功能、肾功能、肝炎系列及血液生化等检查。供、受者ＡＢＯ血型相同者4例,相容者1例;群体反应性抗体(Ｐ…     

活体亲属肾移植(附2例报告)

我院 2 0 0 0年 2月及 2 0 0 1年 3月行活体亲属肾移植术 2例 ,取得满意效果 ,现报道如下。1　病例报告例 1　女 ,36岁。因多囊肾并右侧脓肾于 1 999年 5月行右肾切除术。术后 3个月再出现发热 ,肾功能明显下降而行血液透析半年。因患者左肾曾发生过感染 ,为避免术后再感染 ,于 2 0 0 0年 2月 2 8日行右侧多囊肾切除 ,同时行活体亲属肾移植术。供者为受者的弟弟 ,32岁。既往身体健康 ,无高血压病史 ,血、尿常规 ,肝、肾、心、肺功能等检查无异常。Ｂ超检查右肾集合系统可见 0 .3ｃｍ× 0 .2ｃｍ之强光团 ,拟诊右肾小结石。ＫＵＢ及ＩＶＵ无…     

50岁以上亲属活体肾移植供者安全性分析

目的 探讨50岁以上亲属活体供肾移植供者的安全性. 方法 1993年4月至2007年12月行年龄>50(51～78)岁亲属活体供肾移植45例,同期年龄≤50岁供者62例作为对照组.比较2组供者手术前后SCr、GFR变化,手术并发症及术后随访情况. 结果 供肾手术均获成功.2组供者术前SCr分别为(82.16±10.86)和(78.66±10.41)μmol/L,术后1周、1个月及12个月分别为(106.00±8.68)、(86.62±10.81)、(83.18±9.19)μmol/L和(103.89±9.29)、(85.65±7.42)、(80.32±8.89)μmol/L,组问比较差异均无统计学意义(P>0.05);2组术前GFR分别为(85.82±6.26)和(88.74±9.44)ml/min,术后1、12个月分别为(49.76±3.57)、(60.32±4.42)ml/min和(51.36±5.39)、(62.10±6.31)ml/min,组间比较差异均无统计学意义(P>0.05).2组供者术后平均住院时间分别为9及8 d.>50岁组术中发生胸膜损伤2例,术后切口疼痛、下腹部麻木感4例,切口脂肪液化1例;对照组发生胸膜损伤1例,术后切口疼痛、下腹部麻木感9例.>50岁组供者随访37(12～180)个月,肾功能正常.结论 高龄不是亲属活体供肾绝对禁忌证,术前全面系统评估及术中仔细操作是高龄供者术后安全性的重要保证.     

The pre-transplant anemic condition is independent of long-term outcome in living-related kidney transplantation

The relationship between pre-transplant Hemoglobin (Hb) concentration and long-term outcome of living-related kidney transplantation is far from well addressed. A retrospective cohort study was conducted by reviewing the medical profile of the patients who received living-related kidney transplantations at our center from January 2006 to January 2013. Patients were divided into two groups: high Hb group (≥10?g/dL) and low Hb group (<10?g/dL). Cox regression model was utilized to analyze the effect of pre-transplant hemoglobin concentration on the patient and graft survival. About 422 patients were of Hb level <10?g/dL (78.30?±?14.18?g/dL), 280 were >10?g/dL (116.2?±?14.43?g/dL) (p?p?=?0.096; and 4.04% vs. 2.14%, p?=?0.165, respectively). Cox regression model revealed that pre-transplant Hb level <10?g/dL was independent of increased overall mortality (HR?=?3.379; 95% CI: 0.706–17.172) and increased death censored allograft failure risk (HR?=?1.556; 95% CI: 0.595–4.069). Pre-transplant Hb concentration <10?g/dL is independent of poor long-term outcome of living-related kidney transplantation.     

Living-related transplantation of an ectopic pelvic kidney

Ectopic kidneys are usually contraindicated for transplantation as a result of anomalous vascular and drainage system. Graft shortage increases the need of expanding the donor pool and the use of ectopic pelvic kidneys might provide a small but useful source. Transplantation of an ectopic pelvic kidney is a technically demanding procedure and very few cases have been published. We present a case of a living-related kidney transplantation of an ectopic pelvic kidney. The donor was a healthy 65-year-old lady and preoperative work-up had showed a left ectopic pelvic kidney. The recipient was a 34-year-old male with a history of end-stage renal disease secondary to chronic glomerulonephritis. After the transplantation, there was an immediate function of the allograft and the donor's postoperative course was uneventful. The donor was discharged on the fifth postoperative day.     

Effect of donor age on the outcome of living-related kidney transplantation

The study compared the results of kidney transplantation from living-related donors older and younger than 60 years. The 273 kidney graft recipients were divided into group 1 (115 recipients of older grafts) and group 2 (158 recipients of younger grafts). The frequency of acute rejection (AR) episodes was similar in both groups but slow graft function occurred more frequently in group 1. The frequency of chronic renal allograft dysfunction in the first post-transplant year was significantly higher in group 1 than in group 2. Patient and graft survival was significantly worse in group 1. Risk factors for graft loss were the difference between donor and recipient age and AR. Donor age and graft function were risk factors for patient death. Although kidneys from older donors provide a statistically poorer transplant outcome, they are clinically acceptable, especially when waiting time is prolonged and access to dialysis limited.     

Psychosocial impact of living-related kidney transplantation on donors and partners

Living-related kidney transplantation (LRKT) is an option for children with end-stage renal failure. In addition to medical concerns, there is uncertainty about the psychological impact of living-related donation on parent donors and families. A survey was conducted on the decision making process and medical and psychosocial consequences of LRKT. Between 1992 and 1999, 20 parents donated a kidney for their child. A questionnaire including 24 items was sent to parent donors and their partners. Nineteen parents and partners responded; the median time after LRKT was 3 years. Donors and partners reported an independent decision making process with no significant influence of partners, relatives, or hospital staff. Partners were more concerned about medical problems than donors themselves (P <0.02). Donors and partners cited no medical problems except sustained pain. Both reported an improved personal relationship towards the transplanted child. Donors and partners also cited an improved personal relationship. The vast majority (18/19) of couples still supported the decision for organ donation. In conclusion, there was a high degree of satisfaction with the decision making process in LRKT. The great majority of donors and partners did not report negative medical or psychological consequences. The relationship between donor, partner, and recipient child improved after LRKT.     

Pulmonary embolism in a living-related kidney transplantation donor

Living-related renal transplantation is the optimal therapy for patients with end-stage renal disease (ESRD). Normally, complications are rare in living-related donor nephrectomy. However, we experienced a case of pulmonary embolism (PE). The incidence of PE in living donor nephrectomy is rare, but the total incidence of PE in surgical operations has recently increased. The patient in the case reported here was diagnosed relatively early and recovered with appropriate treatment. It is very important for surgeons to realize that serious complications such as PE can develop in any case of living donor nephrectomy. Received: May 1, 2001 / Accepted: January 8, 2002 Acknowledgment. This work was supported in part by a Grant-in-Aid for Research on Human Genome, Tissue Engineering Food Biotechnology, Health Sciences Research Grants, Ministry of Health, Labor and Welfare of Japan. Reprint requests to: H. Ushigome     

222例活体肾移植供受者HLA分型配合率的分析

目的 研究活体亲属肾移植供受者HLA配合率,为临床选择良好的供受者HLA配型提供参考.方法 对2006年4月-2008年12月间手术的222例活体亲属肾移植患者进行HLA供受者配合率分析.移植受者男性168例,女性54例,最大年龄58,最小年龄10岁;移植供者男性133例,女性89例,最大年龄64岁,最小年龄21岁.结...     

Successful treatment of small-for-size syndrome in adult-to-adult living-related liver transplantation: single center series

The portal hyperperfusion, or small-for-size syndrome (SFSS), is a widely recognized clinical complication that may occur after segmental liver transplantation. Several surgical strategies have been proposed to reduce portal blood inflow and portal pressure after partial liver transplantation. In particular, splenic artery ligation and splenectomy have been used without a firm hemodynamic basis for these procedures. Our group recently demonstrated that, in patients with cirrhosis and portal hypertension, the occlusion of the splenic artery causes a significant reduction in the portal pressure gradient, which is directly related to the spleen volume and indirectly related to the liver volume. This concept is at the center of our strategy for performing early splenic artery embolization (SAE) for the treatment of SFSS after living-related liver transplantation (LRLT). Six patients developed small-for-size syndrome, defined as: onset within the first week after LRLT of progressive hyperbilirubinemia without mechanical cause; marked cholestasis; centrilobular sinusoidal dilatation and hepatocyte atrophy at liver biopsy; and refractory ascites in the absence of vascular complications. All six patients who underwent SAE rapidly improved their clinical condition, with an evident decrease in the value of bilirubin in the serum, in the production of ascites, and improvement in condition of pancytopenia. Coagulopathy expressed by the international normalized ratio value (INR) was not a reliable early marker of SFSS in this series; in fact a slight improvement in the result of this test was already present immediately after LRLT and before SAE. Because splenic flow clearly contributes to portal hyperperfusion, an early SAE can relieve the partial graft from the deleterious effect of this portal overflow.     

Optimal timing for living-related liver transplantation in children

BACKGROUND: The pediatric end stage liver disease (PELD) score has been used widely to prioritize children awaiting cadaveric liver transplantation (LTx). To establish the objective parameter for optimal timing of living-related LTx (LRLTx), we have assessed our cases using the PELD score. METHODS: From 1997 to 2002, 24 children were evaluated 28 times for the indication of LRLTx. Among them, 15 were for jaundice and nine for growth failure, hepatopulmonary syndrome, and variceal bleeding. Nine of 24 children underwent LRLTx. They were divided into several groups according to their clinical course. The PELD score consisted of age, albumin, total bilirubin, prothrombine time-international ratio (INR) and growth failure. A cut-off value was obtained by the highest positive and negative predictive value. RESULTS: The PELD score in cases whose indication for LRLTx was approved was significantly higher compared with the cases who were not, and a cut-off value of 4 was obtained. The PELD score in cases who were alive after LRLTx was significantly lower compared with the cases who died after LRLTx or evaluation of the indication, and a cut-off value of 22 was established. CONCLUSION: LRLTx may be considered when the PELD score exceeds 4, and LRLTx may be required immediately when the PELD score exceeds 22.     

Anesthesia care for living-related liver transplantation for infants and children with end-stage liver disease: report of our initial experience

STUDY OBJECTIVE: To describe our initial experience of the perioperative anesthetic care provided to pediatric recipients during living-related liver transplantation. DESIGN: Cohort review of the perioperative anesthetic care for living-related liver transplantation. SETTING: Tertiary referral and postgraduate teaching hospital. PATIENTS: 27 children (20 males, 7 females) with end-stage hereditary metabolic liver disease requiring living-related liver transplantation. INTERVENTION: Perioperative care was administered during living-related liver transplantation. MEASUREMENTS: The major intraoperative physiologic events and concerns are described, as well as the anesthesia technique for pediatric living-related liver transplantation anesthesia. Intraoperative changes in physiologic parameters and the intraoperative requirements in our series are also reported. MAIN RESULTS: During a 30-month period, 27 children (20 males and 7 females) were scheduled for transplantation with an hepatic graft from a living-related donor. Twenty-six children received a graft from a living-related donor, and one was retransplanted with a cadaveric graft because of graft failure, and one child received a cadaveric graft because of the lack of a suitable donor. All patients received intravenous (IV) anesthesia with fentanyl, midazolam, and cisatracurium, and were ventilated with oxygen/air. Mean induction and presurgical preparation time was 1.18 hours, with a surgical time of 6.55 hours. All but one patient was extubated on the evening of the operating day after receiving a mean dose of 8.67 microg kg(-1) hr(-1) of fentanyl and a mean dose of 0.124 mg kg(-1) hr(-1) midazolam. The need for crystalloid infusion was 24.0 mL kg(-1) hr(-1), fresh frozen plasma (FFP)16.63 mL kg(-1) hr(-1), and red blood cells 7.98 mL kg(-1) hr(-1). There was no mortality and no anesthetic-related morbidity in our series. CONCLUSIONS: Total IV anesthesia with fentanyl, midazolam, and cisatracurium, after preoperative optimization, is a well-tolerated approach for children undergoing living-related liver transplantation and offers quick recovery. This anesthetic technique was aimed at minimizing the effects on the cardiovascular system, and also any consequences related to the possible occurrence of a reperfusion syndrome. Fluid balance was aimed at optimizing flow through the hepatic graft and preventing thrombosis of vascular anastomoses.     

Changes in liver regenerative factors in a case of living-related liver transplantation

Liver regeneration in a patient with fulminant hepatic failure (FHF) who underwent living-related partial liver transplantation (LRLT) was investigated regarding hepatic growth factors. The patient was a 16-yr-old Japanese male who developed severe subacute FHF. LRLT was performed using an extended left lobe of the ABO matched patient's mother. In the recipient, the pre-transplant levels of both plasma hepatocyte growth factor (HGF) and transforming growth factor (TGF)-beta were extremely high and rapidly decreased following the liver replacement. The liver volume evaluated using a CAT scan increased 195% after 2 wk in graft liver and 110% after 2 wk in the hepatectomized donor. The explanted liver (FHF liver), the liver from donor (normal liver), and the graft liver [the 3rd post-transplant day (POD 3)] were all investigated immunohistochemically. FHF liver: No liver regeneration was observed [proliferative cell nuclear antigen (PCNA) labeling index (L.I.): 0%]. In the liver, both HGF in the hepatocytes and c-met on the membrane of the hepatocytes were positive. TGF-beta was positive in the hepatocytes and no apoptosis was detected by the TUNEL method. Donor liver (POD 0): Few PCNA stained hepatocytes were detected. No HGF was detected but c-met was clearly detected on the cell membrane of the hepatocytes. Neither TGF-beta nor apoptosis was detected. Graft liver (POD 3): The PCNA L.I. was conspicuous at 40%. HGF was positive in non-parenchymal cells and c-met was positive in the cytoplasm of the hepatocytes. TGF-beta was negative while apoptosis was positive in the zone 3 hepatocytes. In conclusion, these findings suggested that the liver of the patient with FHF did not respond to liver regenerative stimulus, in part, through involvement of inhibitor TGF-beta. On POD 3, the transplanted graft was in a vigorous regenerative status in comparison to that in the hepatectomized donor. The HGF/c-met system is thought to be involved in the mechanism of regeneration. Intrahepatic apoptosis was detected in the graft on the 3rd post-transplant day probably due to transient ischemia in the liver, which was not related to the Fas/Fas-ligand system.