活体供肾肾小球滤过率对受体中远期肾功能的影响

目的探讨活体肾移植供肾肾小球滤过率(GFR)对受体中远期肾功能的影响。方法 2005年至2010年在中山大学附属第一医院移植中心接受活体肾移植治疗的无急性排斥反应、无移植肾功能延迟恢复的167例供受体为研究对象,其中亲属关系161例(97.0%)、夫妻关系5例(2.4%),帮扶关系1例(0.6%)。术前应用放射性核素99m TC-DTPA肾动态显像测定供体左右肾GFR。供体的双肾GFR为60.5~147.6 ml/min,将对象分为供肾GFR46ml/min 82例和供肾GFR≥46 ml/min 85例。两组受体的术前透析情况、HLA错配率,移植肾冷、热缺血时间、抗体诱导及免疫抑制方案等基本资料相似,评价患者术后中远期肾功能变化情况。结果与供肾GFR46 ml/min组比较,供肾GFR≥46 ml/min组的血肌酐(Scr)在术后3年,4年较低,5年较高,术后3年、4年、5年的差异均无统计学意义(P0.05)。重复测量的方差分析显示术后3~5年两组受体Scr变化差异无统计学意义(P0.05)。相关分析法显示供者术前肾小球滤过率与受者术后3年、4年、5年Scr之间无相关关系。(r值分别为-0.023,-0.042,0.005,P0.05)。结论活体肾移植供肾GFR高低对受体术后中远期(3~5年)的Scr整体水平及变化趋势无显著影响。

Effect of donor GFR on long-term renal function of recipients with living donor transplantation

Objective To study the influence of donor glomemlar filtration rate （GFR） on the long-term renal function in recipients undergoing living donor transplantation. Methods A total of 167 living donor transplant recipient without acute rejection and delayed graft function in the First Affiliated Hospital of Sun Yat-sen University Transplantion Center from 2006 to 2010 were enrolled into this study.Among them, 161 were genetically related （96.5%）,while 6 were genetically unrelated （5 spouses and 1 other）.The predonation GFR was measured by isotope clearance （99mTC-DTPA with few exceptions）.The range of donor GFR was 60.5 to 147.6 ml/min.The recipients were classified into two groups according to donor graft GFR level （GFR〈46 ml/min, n--82; GFR/〉 46 ml/min, n =85）.The predonation dialysis, HLA mismatch, cold and warm ischemia time,antibody induction and immunosuppressive regimens were not significantly different between two groups.The changes of long-term renal function of postoperativerecipients were assessed.The relationship between the predonation GFR of the donor and the postoperative Scr of kidney recipients at year 3,year 4 and year 5 were analyzed by correlational analysis method.The postoperative Scr of recipients at each time point were compared by using repeated-measure ANOVA. Results The postoperative Scr of GFR≥46 ml/min group at 3 years,4 years were lower and at 5 years were higher that then those of GFR〈46 ml/min group. There were no significant differences in the postoperative Scr of two groups at 3 years, 4 years and 5 years（P〉0.05）. A repeated-measure ANOVA revealed nosignificant differences were found in Scr variation of two groups in 3-5 years after transplantation（P=0.508）. Correlational analysis showed that there was no relevant relationship between predonation GFR of the donor and the postoperative Scr of kidney recipients （r=-0.023,-0.042,0.005,P〉0.05）. Conclusion Predonation GFR of the donor has no significant effect on the long-term Scr of postoperati