亲属活体供肾移植40例临床分析

总结40例亲属活体肾移植的临床观察要点,以及供者选择、配型结果与移植疗效的关系.选择解放军总医院第二附属医院2007-01/2008-07亲属活体肾移植40例进行回顾性分析,其中夫妻间供肾2例,血缘亲属供肾38例;ABO血型相同38例,相容2例:人类白细胞抗原无错配1例,4位点错配者4例,2位点错配者20例,1位点错配者16例;37例取供者左肾,3例取供者右肾.移植后采用环孢素A或他克莫司、霉酚酸酯及醋酸泼尼松预防排斥反应.39例受者移植肾功能恢复正常时间为(6.17±1.91)d,1例发生移植肾功能延迟恢复,2例移植后发生巨细胞病毒感染,更昔洛韦治疗后痊愈,2例发生肺部感染,减少免疫抑制剂用量及抗感染治疗后痊愈,2例术后3个月内发生急性排斥反应,激素冲击治疗后逆转.全部供者术后恢复顺利,于7～10d内出院,复查肝、肾功能均正常.提示移植前对供、受者双方进行全面评估,对供、受者手术前后特殊情况及时观察、及时处理是亲属活体肾移植预后的关键,对提高生存率,降低感染率有重要意义.

Clinical analysis of living-related donor kidney transplantation in 40 cases

To summarize clinical observation points of living related donor kidney transplantation in 40 cases,as well as the correlation of donor selection,the matching results with efficacy of transplantation.Forty cases underwent living related donor kidney transplantation were selected from the Second Hospital Affiliated to General Hospital of Chinese PLA from January 2007 to July 2008 and were analyzed retrospectively,among these cases,2 were marital donors,38 were relative donors,38 were in the same blood group of ABO,2 were compatible cases;1 was matched in human leukocyte antigen,4 were mismatched in four sites,20 were mismatched in two sites,16 were mismatched in one site;37 cases donated the left kidney,while 3 cases the right kidney.Thirty nine recipients returning to normal renal function following renal transplantation was (6.17 ±1.91)days,1 cases was present with delayed recovery of graft renal function,2 cases occurred cytomegalovirus infection after surgery and recovered after ganciclovir treament,2 cases occurred pulmonary infection and were healed after reducing the dosage of immunosuppressants and anti-infection treatment,2 patients occurred acute rejection reaction within 3 months after surgery and reversed after intravenous glucocorticoid therapy.All of the donors were successfully restored after surgery,discharged from the hospital in 7 to 10 days,the reexamination of hepatic and renal function were normal.It is suggested that the completely evaluation before transplantation,observing and dealing with the special circumstances before and after the surgery of all donors and recipients are the key of living-related donor kidney transplantation prognosis,also have important significance to raise survival rates and reduce infection rates.