心脏死亡供者肾移植48例临床分析

目的:探讨终末期肾病患者接受心脏死亡无偿器官捐献(DCD)供者移植后的恢复情况及此类供体对受者及移植物术后的影响。方法:对48例终末期肾病患者接受DCD捐献的肾脏后行同种异体肾移植术,并对其术前和术后的诊疗及随访血肌酐、移植物及受者存活情况进行回顾性分析。结果:48例受者中无1例出现移植肾原发性无功能(PNF),18例受者术后出现肾功能延迟恢复(DGF),其发生率为37.5%,DGF组与无DGF组受者及移植肾生存率比较,差异无统计学意义(分别P=0.098,P=0.447)。48例受者中有7例(14.6%)受者移植肾丢失,其他41例受者随访时间为0.5~23(中位数8)个月,39例(95.1%)受者移植肾功能恢复正常。在1,3,6,12个月移植物的存活率分别为95.7%,93.0%,90.0%,87.5%,患者的存活率分别为100%,94.9%,90.0%,87.5%。结论:在我国尚无脑死亡法的环境下,DCD是解决我国器官移植界瓶颈的重要手段,是器官来源的重要部分,并且有着较好的短中期预后。

Clinical analysis of 48 cases of kidney transplantation from cardiac death donors

Objective: To evaluate the recovery of patients with end-stage renal disease(ESRD) receiving kidney transplant from cardiac death donors,and to assess graft survival in China from this type of donor. Methods: A total of 48 cases of patients with ESRD have received the kidneys from cardiac death donors in our hospital between February 2010 and March 2012.We retrospectively analyzed data on the preoperative and postoperative serum creatinine concentrations,on the survival of recipients and allografts with a view to investigating prognoses after this type of kidney transplant. Results: Primary non-function(PNF) did not occur in any of the 48 recipients.Delayed graft function(DGF) occurred in 18 of 48(37.5%) of kidneys from cardiac death donors,but the occurrence of DGF did not adversely influence patient’s survival(P=0.098) or graft survival(P=0.447).Seven of 48(14.6%) recipients lost their graft.Over a median follow-up period of 8 months(range 0.5–23 months),39 of 41(95.1%) recipients’ graft function had fully recovered.The actuarial graft and patient’s survival rates at 1,3,6 and 12 months after transplantation were 95.7%,93.0%,90.0%,87.5%,and 100%,94.9%,90%,87.5%,respectively. Conclusion: As the legislation of donation after brain death(DBD) has not been ratified in China,the use of kidneys from cardiac death donors might be an effective way to increase the number of kidneys available for transplantation here.Our experience indicates good short-and mid-term outcomes with transplants from cardiac death donors.