伴急性肾损伤的脑死亡器官捐献供者供肾移植治疗的体会

目的  总结伴急性肾损伤（AKI）的脑死亡器官捐献（DBD）供者供肾移植的治疗效果。方法  选取成功完成DBD供肾移植的59例供者纳入本研究，根据入重症监护室（ICU）时的血清肌酐（Scr）水平，将DBD供者分为AKI组（14例）与正常组（45例），相应的101例受者根据供者情况分为AKI组（23例）与正常组（78例）。总结59例供者器官捐献情况，比较两组供者获取前的主要指标。比较两组受者术后肾功能、住院情况及临床结局。结果  59例供者中，14例发生AKI（24%），其中2例在其维护期间行持续性肾脏替代治疗。与正常组供者相比，AKI组供者的急性生理与慢性健康（APACHE）Ⅱ评分明显升高（P＜0.05），中枢性尿崩症的发生率更高（P＜0.01），入ICU时和获取前的Scr水平更高（均为P＜0.01），获取前24 h尿量更少（P＜0.01）。与正常组受者相比，AKI组受者术后2、3 d的Scr水平更高（均为P＜0.05），住院时间和住院花费亦明显升高（P＜0.01，P＜0.05）。两组受者术后移植肾功能延迟恢复、急性排斥反应、感染、恢复透析的发生率比较，差异无统计学意义（均为P＞0.05）。术后3个月，两组受者均好转出院，移植肾存活率为100%。结论  伴AKI的DBD供者供肾移植，经过积极的器官维护可纠正AKI，达到与非AKI供肾同样的效果，可以作为扩大供肾来源的途径。

Experience of clinical efficacy of renal transplantation from donors of donation after brain death complicated with acute kidney injury

Objective To summarize the clinical efficacy of renal transplantation from donors of donation after brain death (DBD) complicated with acute kidney injury (AKI). Methods Fifty-nine DBD donors successfully undergoing renal transplantation were recruited in this investigation. According to the Scr level upon admission of intensive care unit (ICU), DBD donors were divided into the AKI group (n=14) and control group (n=45). A total of 101 recipients were assigned into the AKI group (n=23) and control group (n=78) correspondingly. The organ donation conditions of 59 donors were summarized. Main parameters of the donors before organ procurement were statistically compared between two groups. Postoperative kidney function, hospitalization condition and clinical outcomes of the recipients were statistically compared between two groups. Results Among 59 donors, 14 cases (24%) suffered from AKI. Two donors received continuous renal replacement therapy during organ maintenance. Compared with the donors in the control group, the APACHE Ⅱ score of the donors was significantly higher (P < 0.05), the incidence of central diabetes insipidus was considerably higher (P < 0.01), the Scr levels at admission of ICU and before organ procurement were significantly higher (both P < 0.01) and the amount of urine at 24 h before organ procurement was dramatically less in the AKI group (P < 0.01). Compared with the recipients in the control group, the Scr levels at postoperative 2 and 3 d were significantly higher (both P < 0.05), the length of hospital stay was considerably longer (P < 0.01) and the hospitalization expanse was significantly higher in the AKI group (P < 0.05). No statistical significance was observed in the postoperative delayed recovery of renal graft function, incidence of acute rejection, infection and rehabilitation dialysis in the recipients between two groups (all P > 0.05). At 3 months after transplantation, the recipients in two groups were discharged and the graft survival rate was 100%. Conclusions For renal transplantation from DBD donors complicated with AKI, active measures should be taken to maintain the organ and relieve the AKI, which yields similar clinical efficacy to renal transplantation from non-AKI donors and widens the origin of kidney graft.