亲属活体肾移植的临床分析和移植肾组织病理分析  

Clinical and histopathological analysis in living donor kidney transplantation recipients

作　　者：刘斌[1] 曾凡军[1] 郭晖[1] 朱兰[1] 陈忠华 

机构地区：[1]华中科技大学同济医学院附属同济医院器官移植研究所卫生部/教育部器官移植重点实验室,武汉430030

出　　处：《中华器官移植杂志》2006年第5期274-276,共3页Chinese Journal of Organ Transplantation

基　　金：国家自然科学基金资助项目(30200263)

摘　　要：目的 总结亲属活体肾移植后移植肾组织活检资料，并结合临床进行回顾性分析。方法亲属活体肾移植55例，其中有血缘的亲属供肾移植53例，夫妻间供肾移植2例。供、受者间HLA配型，1条单倍型相同者45例，2条单倍型相同者6例，5个抗原错配者3例，完全错配者1例。除1例采用腹腔镜取肾外，其余均采取开放手术取肾。供肾热缺血时间1～8min，冷缺血时间1～2h。术后应用环孢素A（或他克莫司）、硫唑嘌呤（或霉酚酸酯）及泼尼松预防排斥反应。结果 55例中，有10例接受16次移植肾活检，结果 4例次为急性排斥反应（Banff分级均为Ⅰ级），3例次经甲泼尼龙冲击治疗逆转，1例合并慢性移植肾肾病，治疗无效，恢复透析；3例次为移植肾退行性病变（其中2例合并急性环孢素A肾毒性损伤），2例减少环孢素A用量，并加用西罗莫司，效果良好，1例将环孢素A转换为西罗莫司，效果不佳，恢复透析；4例次为急性肾小管坏死，采用他克莫司和霉酚酸酯联合用药，并辅以透析治疗，肾功能恢复正常。结论 虽然亲属活体肾移植术后急性排斥反应和移植肾功能恢复延迟的发生率低，但仍应重视术后移植肾组织活检，将被动活检转为主动的计划性活检，以提高亚临床排斥反应的检出率。Objective To make a retrospective analysis of kidney allograft biopsy combined with clinical data in living donor kidney transplantation （LDKT） recipients. Methods Fifty-five patients within whom 53 cases donated by living-related donors and 2 cases by spouse underwent LDKT. As to HLA matching, 45 cases shared one haplotype, 6 cases shared two haplotypes, Ⅰ fully mismatch and the other 3 with 5-coli mismatch. Except one donor underwent laparoscopic nephrectomy, the others underwent open nephrectomy. Warm ischemia time of grafts varied from one min to 8 min, and cold ischemia time one h to 2 h. Triple-combined immunosuppressive regimes included calcineurin inhibitors （CNI） such as cyclosporine or tacrolimus, anti-proliferative agents as azathioporine or mycophenolate mofetil and costisteroid. Results Ten recipients （male 8, female 2） underwent allograft biopsy for 16 times. Acute rejection fAR） episodes （grade 1, banff classification） appeared in 4 patients within which 3 cases being reversed by high intravenous dose of methylprednisolone, but the other one lost kidney graft. Evidence of chronic retrogressive nephropathy of donor kidneys was detected in 3 cases in which 2 patients gained long-term graft survival through reduction of CNI combined with sirolimus （SRL）, and acute tubular necrosis （ATN） appeared in 2 cases. Conclusions In living donor kidney transplant, the role of allograft biopsy is considerable even with low incidence of AIR episodes and delayed graft function. Programmed biopsy is preferable to make early diagnosis of subclinical acute rejection.

关 键 词：肾移植 活体供者 活组织检查 针吸 

分 类 号：R699.2[医药卫生—泌尿科学] R692.6[医药卫生—外科学]