亲属活体肾移植15例分析

目的分析15例亲属活体肾移植的临床效果。方法15例亲属活体’肾移植中，其中同胞供肾5例，父母供肾6例，妻子供肾3例，婶→侄供肾1例。ABO血型配合符合输血原则。HLA6位点配型：全配1例；单倍体相同8例；4位点相同1例；3位点相同1例；1位点相同3例；全不配1例。供受者淋巴细胞毒交叉配合实验均为阴性。群体反应性抗体均〈10％。经开放手术取肾13例，经腹腔镜取肾2例。供者选择右肾1例，选择左肾14例。受者术后均接受环孢素A（或他克莫司）、霉酚酸酯和泼尼松预防排斥反应。结果所有供者均无并发症发生，10日内出院，随访至今肾功能无异常。受者：1例发生不典型急性排斥反应，给予抗T淋巴细胞猪免疫球蛋白加甲强龙治疗后逆转；2例发生尿瘘，保守治疗后治愈；1例肾功能延迟恢复，术后半年并发心脏疾病死亡；1例术后半年发生乙型病毒性肝炎死亡；其他13例随访至今肝肾功能正常，无感染等并发症。结论亲属活体肾移植是解决供肾来源短缺的重要方法，经过全面的医学评估合格的供者，捐献一个肾脏对他们来说安全的。亲属供肾移植具有良好的临床效果，是治疗终末期肾病的有效手段，是有效的家庭内自救方案。

Fifteen cases of living -related donor renal transplantation

Objective To discuss the clinical efficiency of living-related donor renal transplantation.Methods Fifteen cases of living-related donor renal transplantation included 5 cases of brother or sister donor,6 of parent donor,3 of wife donor,1 of aunt donor.ABO blood group was compatible.HLA matching:1 case was complete matching,8 cases haploidentical matching,1 matching in 4 loci matching,1 matching in 3 loci matching,3 matching in 1 lucus matching,1 with complete mismatching.All cases had negative lymphocytotoxity and low level PRA(<10%).Open surgery was adopted for 13 cases,retroperitoneal laparoscopic surgery for 2 cases.Ciclosporin A or tacrolimus,Anti-human T Lymphocyte Porcine Immunoglobulin(ALG)and methylprednisolone(MP) were combinedly used to prevent rejection.Results All donors left hospital in 10 days without any complications and their renal function are normal up to the present.One recipient experienced atypical acute rejection 2 months after operation and cured with ALG plus MP.Two patients had a urinary fistula and conservative treatment was effective.One case suffering from delayed graft function died of heart trouble half year after operation.One case died of viral hepatitis type B half year after operation.Other 13 cases had normal liver and renal function without complications such as infection.Conclusion Deficient in kidney source,it is a important approach to carry out living-related donor renal transplantation for patients with end-stage renal disease(ESRD).It is safe for eligible donor to donate a kidney.Living-related donor renal transplantation has favorable clinical effect and is a valid treatment for patients with ESRD.