50岁以上活体亲属供肾移植的中期疗效分析  

Median-term therapeutic effect of renal transplants from older living donors

作　　者：陈立中[1] 张磊[1] 费继光[1] 王长希[1] 邱江[1] 邓素雄[1] 李军[1] 陈国栋[1] 黄刚[1] 傅茜[1] 

机构地区：[1]中山大学附属第一医院器官移植外科,广州510080

出　　处：《器官移植》2010年第1期45-49,共5页Organ Transplantation

基　　金：中山大学临床医学研究5010计划项目(2007003)

摘　　要：目的探讨50岁以上活体亲属供肾移植的早期并发症和中期疗效。方法2004年至2008年间实施的活体亲属肾移植139例,按供肾年龄50岁为界限分为供体≥50岁以上的受体40例(50岁以上供体组)、供体<50岁的受体99例(50岁以下供体组),两组的透析情况,冷、热缺血时间,使用抗体诱导和HLA错配等基线资料相似。随访12～24个月,评价两组受体移植后的早期并发症和中期疗效。结果移植术后两组的急性排斥反应、移植物功能延迟恢复(DGF)发生率比较差异无统计学意义(P>0.05)。与50岁以下供体组比较,50岁以上供体组术后1个月、3个月、6个月、12个月、24个月5个随访时点的Scr偏高、CCr偏低。重复测量的方差分析显示术后1年内两组受体的Scr和CCr的变化趋势差异均无统计学意义(P>0.05)。50岁以上供体组和50岁以下供体组术后12个月人存活率分别为100%和98%,移植物存活率分别为98%和98%,24个月时人存活率分别为100%和96%,移植物存活率分别为97%和96%,差异均无统计学意义(P>0.05)。结论50岁以上老年供肾的中期疗效理想,在肾源紧缺的情况下可考虑选用,其远期效果仍需继续随访。Objective To study early complication and median-term therapeutic effect of renal transplants from living donors more than 50 years old.Methods 139 consecutive living donors and recipients were enrolled in our cohort study from 2004 to 2008.The recipients were classified into two groups according to the donors＇ age：older than 50 （n=40,OLD group） and 50 or younger （n=99,YLD group）.There was no significant difference in the characteristics between these two groups.The follow-up period was from 12 to 24 months and early complications as well as mid-term therapeutic effect were evaluated in all recipients.Results There were no significant between-group differences in the incidence of postoperative acute rejection and delayed graft function （DGF）.Postoperative serum creatinine （Scr） was higher in the older group at 1,3,6,12 and 24 months after operation while the creatinine clearance rate （CCr） was lower compared with the younger group.No significant difference was observed in the Scr and CCr between two groups with repeated-measures ANOVA in the first postoperative year.The survival rates of patients in the OLD group and YLD group were 100% and 98% at 12 months post-transplantation,and 100% and 96% at 24 months,respectively.The survival rates of grafts were 98% and 98% at 12 months,and 97% and 96% at 24 months,respectively.There was no significant between-group difference.Conclusion The median-term therapeutic effect of transplants from living donors more than 50 years old is clinically acceptable,and a long-term follow up is needed.

关 键 词：肾移植 活体供者 年龄因素 血清肌酐 内生肌酐清除率 

分 类 号：R473.6[医药卫生—护理学]