亲属肾移植供者77例移植前医疗评估  

Medical assessment of living-relative kidney donors prior to transplantation in 77 cases

作　　者：王强[1] 蔡明[1] 石炳毅[1] 钱叶勇[1] 李州利[1] 裴向克[1] 许亮[1] 

机构地区：[1]解放军总医院第二附属医院器官移植中心泌尿外科,北京市100091

出　　处：《中国组织工程研究与临床康复》2010年第5期874-878,共5页Journal of Clinical Rehabilitative Tissue Engineering Research

摘　　要：背景:活体肾移植不仅关系到受者的预后,更重要的是供者的健康利益。在活体肾脏捐赠前,所有的肾脏捐赠候选者必须接受完整的医学和心理学评估,以确保捐赠者的安全。目的:总结分析亲属肾移植供者捐肾前的评估经验。方法:回顾性分析解放军总医院第二附属医院器官移植中心2006-01/2008-03开展的77例亲属肾移植供者捐肾前医疗评估的临床资料。其中,2008-01-20以前依据英国活体供肾指南(2005年版)进行,2008-01-20以后依据活体供肾移植博鳌会议共识进行。依据一般情况、高血压、糖尿病、心血管系统、传染病学、年龄、肥胖、蛋白尿、肾血管、肾功能、供受者HLA分型及医学伦理等12个方面进行循序渐近的系统评估。结果与结论:77例患者中69例评估合格,成功捐赠,移植后痊愈出院,未出现并发症。8例未捐赠者原因:2例高血压合并终末器官损害,2例为糖尿病,1例供肾术中病理证实为恶性肿瘤,1例为乙型肝炎活动期,1例受其妻子家庭阻力,医学伦理未通过。捐赠者平均年龄45.3岁,≥60岁7例,50～59岁24例,30～49岁29例,<30岁9人。父母捐赠给孩子39例,孩子捐赠给父母1例,兄弟姐妹间捐赠19例,三代旁系血清7例,夫妻间捐赠3例。69例成功捐赠者中血压>140/90mmHg(1mmHg=0.133kPa)者8例;成功捐赠者中无自觉心肌缺血症状但心电图ST-T改变者14例;空腹血糖异常者3例;体质量指数平均为23.05kg/m2,均<30kg/m2;传染病评估乙肝表面抗体和乙肝核心抗体阳性者3例,行抗体滴度测定均<500IU/L;肾图评估1.73m2标准体表面积校正后肾小球滤过率为(137.3±28.5)mL/min,左右肾间肾小球滤过率差异无显著性意义(P<0.05);血管三维CT提示左肾多根动脉者3例,占成功捐赠者的4%;术中与血管三维CT不相符者1例,占1%。结果提示,活体肾移植供者评估的首要目的就是确保捐赠者的适应性、安全性和健康性。为了避免捐赠者�BACKGROUND：Living-donor kidney transplantation is not only associated to prognosis of recipients,but also donors＇ healthy.Complete medical and psychological assessment should be performed prior to transplantation to ensure the safety of donors.OBJECTIVE：To analyze and summarize the assessment experience of living-relative kidney donors prior to transplantation.METHODS：Totally 77 cases of living-relative kidney donors admitted at Organ Transplantation Center,Second Affiliated Hospital of General Hospital of Chinese PLA between January 2006 and March 2008 were reviewed.Among them,the analysis was carried out respectively according to the live donor nephrectomy guide of the United Kingdom（2005 Edition） before January 20,2008,and live donor kidney transplantation consensus Boao meeting after January 20,2008.In common practice,hypertension,diabetes mellitus,cardiovascular system,infectious disease study,age,obesity,proteinuria,renal artery,renal function,receptor for HLA typing and medical ethics,were systematically evaluated.RESULTS AND CONCLUSION：Of the 77 cases of assessed patients,69 were qualified,successful donors,and completely cured,without complications.Totally 8 cases of non-donors were due to：2 cases for hypertension combined with end organ damage;2 for diabetes mellitus;1 confirmed malignant tumor in kidney-donated surgery;1 in the activity period of hepatitis B;1 for resistance from his wife with medical ethics.The average age of donors was 45.3 years old,including and 7 cases above 60 years old,24 of 50-59 years old,29 of 30-49 years old,and 9 below 30 years old.There were 39 cases of parent child donation,1 child parent donation,19 siblings donation,7 cases of three generations of collateral serum,and 3 cases of donation between husband and wife.Of successful donors,blood pressure was above 140/90 in 8 cases;Successful donors were without symptoms of myocardial ischemia but 14 cases had consciously ECG ST-T changes;3 cases had abnormal fasting blood glucose.The successful donors＇ body

关 键 词：医疗评估 亲属供者 心理学评估 活体肾移植 移植前评估 

分 类 号：R617[医药卫生—外科学]