肾移植术后超延迟肾功能恢复15例治疗体会

背景：肾脏移植患者急性排斥反应已不再成为术后的主要并发症，延迟肾功能恢复和慢性移植肾肾病仍然是移植患者术后需要面对的问题。目的：总结分析15例术后发生超延迟肾功能恢复的肾移植患者资料，探讨临床经验及治疗对策。 方法：对肾移植后发生超延迟肾功能恢复患者15例进行回顾性分析。15例患者移植后均采用常规剂量的半量(环孢素A 3.0~4.0 mg/kg，他克莫司0.5~1 mg/kg)，并定期监测血药浓度，随时调整免疫用药剂量，采用血液透析/连续性肾脏替代治疗。分析超延迟肾功能恢复诱因，患者观察患者肾功能恢复情况。 结果与结论：术中低血压、供肾热缺血时间过长、早期急性排斥反应、环孢素中毒、外科并发症、动脉粥样硬化致移植肾血液灌流不足可能为患者超延迟肾功能恢复的诱因。患者术后由少尿期开始进入多尿期时间最长者为108 d，平均32~108 d。肾功能正常8例(血清肌酐78~135 μmol/L)，肾功能轻度异常5例(血清肌酐135~300 μmol/L)，血清肌酐> 300 μmol/L者2例。随访时间最长1例11年，至今移植肾功能正常。结果提示，肾移植后尽早行移植肾穿刺活检及移植肾彩超，根据结果采取综合治疗并制订个体化治疗方案可以使大多数的患者移植肾功能恢复正常。

Clinical study of hyper delayed graft function following renal transplantation in 15 cases

BACKGROUND:Delayed graft function (DGF) and chronic allograft nephropathy, rather than acute rejection, puzzle the patients following renal transplantation. OBJECTIVE:To study the cause and the treatment of hyper DGF (HDGF) on 15 cases after renal transplantation. METHODS: Retrospective research was performed on 15 patients with HDGF. All patients received half-dose immunosuppressant (cyclosporin A 3.0-4.0mg/kg, Tacrolimus 0.5-1 mg/kg), the dose was regulated according to plasma concentration, and hemodialysis/continuous renal replacement therapy was performed. Inducement of HDGF recovery was analyzed, and the renal functions were observed.  RESULTS AND CONCLUSION:The cause of HDGF included hypotension, long warm ischemia time, acute rejection, calcineurin inhibitor toxicity, operate-complication, as well as atherosclerosis. The longest duration from oliguria stage to diuresis stage was 108 days, averaged 32-108 days. Eight patients survived with good graft function (averaged serum creatinine level 78-135 μmol/L), 5 patients survived with slight abnormality graft function (averaged serum creatinine level 135-300 μmol/L), and 2 patients with severe renal disfunction (serum creatinine level > 300 μmol/L). The longest follow-up was 11 years, and the graft function was normal. Early renal biopsy, early renal Doppler ultrasound, combined therapy and individualized treatment can help majority of the patients who suffered with DGF survived with normal graft function.