扩大供肾标准的亲属肾移植临床效果分析  

Analysis of marginal donor kidney in living donor kidney transplant

作　　者：李金锋[1] 宋东奎[2] 丰贵文[1] 王跃[1] 庞新路[1] 尚文俊[1] 刘磊[1] 

机构地区：[1]郑州大学第一附属医院肾移植科,450052 [2]郑州大学第一附属医院泌尿外科,450052

出　　处：《中华泌尿外科杂志》2012年第6期421-425,共5页Chinese Journal of Urology

基　　金：郑州大学第一附属医院青年基金（2012-QN0101）

摘　　要：目的探讨扩大供肾标准的亲属肾移植临床效果。方法回顾性分析2005年11月至2011年6月亲属活体肾移植274例的临床资料，按供者情况分为扩大供者标准（供者年龄≥60岁、肾脏解剖结构／功能异常）组（66例）和标准供者组（208例）。扩大标准组供者年龄≥60岁36例，其中合并肾囊肿6例，合并肾结石1例；肾囊肿22例，囊肿直径4～40mm；肾结石4例，结石直径3～6mm；术侧肾小球滤过率（GFR）〈35ml／min4例。统计学比较两组受者术后3、7d，1、3、6、12个月血清SCr值、并发症发生率、急性排斥反应发生率、移植肾功能延迟恢复（DGF）发生率，1、3年人／肾存活率。结果扩大标准组及标准供者组受者术后3、7d血清SCr值分别为（242．7±132．2）、（185．6±148．4）μmol／L和（156．7±86．8）、（122．2±136．8）μmol／L，两组受者第3天与第7天SCr值比较差异均有统计学意义（P〈0．05）；但两组受者术后1、3、6、12个月血SCr、并发症发生率、急性排斥反应发生率、DGF发生率，1、3年人／肾存活率之间比较差异均无统计学意义（P〉0．05）。结论≥60岁健康高龄、直径〈40mm供肾囊肿仍可考虑作为亲属肾移植供者；低GFR应结合供者年龄、供受者体表面积比、供受者体质量比、可通过外科处理纠正等方面综合考虑；供肾结石者应慎重选择。Objective To analyze the clinical effectiveness of using marginal donor kidney in living kidney transplant. Methods From November 2005 to June 2011, 274 cases of living kidney transplant were performed in the First Affiliated Hospital of Zhengzhou University. The cases were divided into the marginal donors group （ Donor ages over 60 years old, suboptimal renal anatomy or physiology） of 66 cases and standard donors group of 208 cases. The clinical data were retrospectively analyzed. The criteria of marginal donors were as follows： 36 cases of donors with age over 60 yrs （6 cases with renal cysts and 1 case with renal calculus） , 22 cases of renal cysts （with diameter range from 4 mm to 40 ram） , 4 cases of renal calculus （with diameter range from 3 mm to 6 mm） , 4 cases of low GFR （under 35 ml/min. The mean recipients＇ serum ereatinine before surgery and after surgery on day 3, day 7, month 1, month 3, month 6, month 12, related complications, the rate of acute rejection and delayed graft function, 1 year, 3 year recipient/kidney survival were compared between the 2 groups, respectively. Results The serum ereatinine levels in the marginal donor group and standard donor group were （242.7 ± 132.2 vs 185.6 ± 148.4） and （156.7 ± 86.8 vs 122.2 _± 136.8） on day 3, day 7 respectively （P 〈0.05）. Nevertheless, there were no significant differences between the 2 groups in recipients＇ serum ereatinines before surgery and after surgery on month 1, month 3, month 6, month 12, peri-operative complications, the rate of acute rejection and delayed graft function, 1 year, 3 year recipient/kidney survival （P 〉 0.05）. Conclusions Healthy old donors and do-nors with renal cyst （the diameter of renal cysts under 40mm） should not be the barriers to organ donation. To those living donors with low GFR, we should consider of donor age, donor/recipient body weight, donor/ recipient body surface area and whether we could deal with the problem by surgical operation. Donor with renal calculu

关 键 词：肾移植 扩大标准的供者 亲属活体供者 回顾性研究 

分 类 号：R699.2[医药卫生—泌尿科学]