伴急性肾损伤的脑-心双死亡器官捐献供肾不影响移植受者短期预后  

Acute kidney injury in donors of donation after brain plus cardiac death does not affect recipients'short-term prognosis in transplantation

作　　者：洪汉利[1] 陈统清[1] 林敏娃[1] 谢碧琴[1] 叶佩仪[1] 肖观清[1] 孔耀中[1] Hong Hanli;Chen Tongqing;Lin Minwa;Xie Biqin;Ye Peiyi;Xiao Guanqing;Kong Yaozhong(Department of Nephrology,the First People's Hospital of Foshan,Foshan 528000,China)

机构地区：[1]佛山市第一人民医院肾内科,佛山528000

出　　处：《中华肾脏病杂志》2019年第1期25-29,共5页Chinese Journal of Nephrology

基　　金：佛山市医学类科技攻关项目(2016AB002441);2013年佛山市创新型城市建设科技项目-佛山市科技平台(2013AG10008).

摘　　要：目的观察合并急性肾损伤(AKI)的脑-心双死亡器官捐献(DBCD)供肾肾移植的临床治疗效果,总结合并AKI供肾的评估和应用经验。方法回顾性分析佛山市第一人民医院2011年9月至2015年9月间45例DBCD供者和对应80例受者肾移植的临床资料,根据供者入住重症监护室(ICU)时的血肌酐(Scr)和尿量水平将DBCD供者分为AKI组(26例)与非AKI组(19例),相应的80例受者根据供者情况分为AKI组(46例)与非AKI组(34例),比较两组供者移植肾获取前的主要指标,比较两组受者术后各种并发症发生率、术后1年人和肾存活率。结果45例供者中26例发生AKI,发生率为57.8%。AKI组供者术前血肌酐水平显著高于非AKI组(P<0.01)。AKI组与非AKI组受者术后功能延迟恢复(DGF)发生率分别为21.7%和8.8%,差异无统计学意义(P>0.05)。AKI组受者术后1年血肌酐水平显著高于非AKI组[(134.9±63.4)μmol/L和(106.6±28.2)μmol/L,P<0.05],但两组受者术后1年人、肾存活率差异并无统计学意义(均P>0.05)。结论供肾合并AKI对移植术后受者DGF发生率及术后1年人、肾存活不会带来更差的影响。合并AKI的DBCD供肾可作为扩大供肾来源的途径。Objective To investigate the clinical efficacy of renal transplantation from donors of donation after brain and cardiac death(DBCD) complicated with acute kidney injury (AKI), and summarize the clinical experience of evaluation and application.Methods The clinical data of the 45 DBCD donors and 80 recipients in the First People's Hospital of Foshan from September 2011 to September 2015 were retrospectively analyzed. DBCD donors were classified into the AKI group (n=26) and non-AKI group (n=19) according to the serum creatinine level and urine output when the donors were admitted to the intensive care unit (ICU) in this hospital. A total of 80 recipients were divided into the AKI group (n=46) and non-AKI group (n=34) correspondingly. The condition of the donors before organ procurement between the two groups was compared, and the incidence of various complications, the 1 years survival rates of recipients and graft after renal transplantation were compared between the two groups.Results Among 45 donors, 26 cases(57.8%) suffered from AKI. The serum creatinine of donors was significantly higher in the AKI group than that in the non-AKI group (P<0.01). The incidence of delayed graft function (DGF) in AKI group and non-AKI group was 21.7% and 8.8% respectively (P>0.05). After 1 years, the serum creatinine of the recipients in AKI group was significantly higher than that in non-AKI group [(134.9±63.4) μmol/L vs (106.6±28.2) μmol/L, P<0.05], but the survival rates of recipients and grafts did no differ between the two groups (both P>0.05).Conclusions The donors combined with AKI do not have a worse effect on the incidence of DGF, the 1-year survival rates of recipients and grafts after transplantation. So, the donors with AKI for transplantation can widen the origin of kidney grafts.

关 键 词：肾功能不全 急性 肾移植 组织和器官获得 急性肾损伤 脑-心双死亡供肾 

分 类 号：R699.2[医药卫生—泌尿科学]