活体肾移植供肾肾小球滤过率对受体早期肾功能的影响  

Effect of donor GFR on early renal function of recipients with living donor transplantation

作　　者：侯敬财[1] 费继光[1] 王长希[1] 邓素雄[1] 黄刚[1] 黎东伟[1] 李军[1] 

机构地区：[1]中山大学附属第一医院器官移植中心肾移植科,广州510080

出　　处：《中华肾脏病杂志》2012年第9期679-682,共4页Chinese Journal of Nephrology

摘　　要：目的探讨活体肾移植供肾肾小球滤过率（GFR）对受体早期肾功能的影响。方法2006年至2011年在本中心接受活体肾移植172例为研究对象，其中亲属供肾166例（96．5％），夫妻供。肾5例（2．9％），帮扶供肾1例（0．6％）。术前应用放射性核素唧C．DTPA肾动态显像测定供体左右肾GFR。供体的双肾GFR为62～148ml／min，将对象分为供肾GFR≤45ml／min受体76例和供肾GFR〉45ml／min96例。两组受体的透析情况、冷、热缺血时间、抗体诱导及免疫抑制方案、HLA错配率等基本资料相似。评价患者术后早期肾功能变化情况。结果两组患者术后急性排斥反应以及肾功能延迟恢复（DGF）发生率差异无统计学意义。与供肾GFR≤45ml／min组比较，供肾GFR〉45ml／min组的Scr在术后1周、1个月、3个月、1年均较低，其中术后1周的差异有统计学意义（P〈0．05）；术后1个月、3个月、1年的差异均无统计学意义。重复测量的方差分析显示术后1年内两组受体Scr变化差异无统计学意义。结论活体肾移植供肾GFR高低对受体术后1周Scr下降水平有影响，供肾GFR高者受体术后1周Scr水平低，但是对受体术后早期（1年内）的Scr整体水平及变化趋势无显著影响。Objective To study the influence of donor GFR on the early renal function in recipients undergoing living donor transplantation. Methods A total of 172 living donor transplant recipients in our kidney transplantation center from 2006 to 2011 were enrolled into this study. Among them, 166 were genetically related （96.5%）, while 6 were genetically unrelated （spouses in 5 and other in 1）. The predonation GFR was measured by isotope clearance （99TC- DTPA with few exceptions）. The range of donor GFR was 62 to 148 ml/min. The recipients were classified into two groups according to donor graft GFR level （GFR≤45 ml/min, n=76; GFR〉45 ml/min, n =96）. The predonation dialysis, cold and warm isehemia time, antibody induction, immunosuppressive regimens and HLA mismatch were not significantly different between two groups. Results There were no significant differences in the incidence of postoperative acute rejection and delay graft function （DGF）. The postoperative Scr of GFR〉45 ml/min group in 1 week, 1 month, 3 months and 1 year was lower compared with the GFR ≤45 ml/min group, and only the difference of Scr in 1 week was significantly different （P〈0.05）. A repeated-measure ANOVA revealed no significant differences were found in Ser variation of two groups during the first year after transplantation. Conclusions Predonation GFR of the donor has effect on the Scr ofpostoperative 1 week of recipients, not on the Set within a year. Recipients with graft GFR≤45 ml/min have lower Scr levels.

关 键 词：肾移植 肾小球滤过率 肌酐 

分 类 号：R699.2[医药卫生—泌尿科学]