中国公民逝世后器官捐献肾移植早期移植肾丢失的原因分析  

Analysis on the causes of early kidney transplant loss from donation after citizen death in China

作　　者：王心强 郭艳华 宫念樵[1] 卢峡 施辉波 朱兰 徐晶 昌盛 杜敦峰 刘斌[1] 蒋继贫 陈刚[1] 林正斌 曾凡军[1] 张伟杰[1] 周平 陈知水[1] 明长生[1] WANG Xinqiang;GUO Yanhua;GONG Nianqiao(Institute of Organ Transplantation,Tongji Hospital,Tonal Medical College ,Huazhong University of Science and Technology,Wuhan 430030,China)

机构地区：[1]华中科技大学同济医学院附属同济医院器官移植研究所教育部/卫生部器官移植重点实验室,武汉430030

出　　处：《临床外科杂志》2018年第12期903-906,共4页Journal of Clinical Surgery

基　　金：国家高技术研究发展计划(863计划)资助项目(2012AA021010)

摘　　要：目的总结公民逝世后器官捐献(DCD)肾移植术后早期移植肾丢失的原因并探讨其预防、诊疗措施。方法施行DCD肾移植病人521例,总结术后3个月内移植肾丢失的原因并探讨其预防、诊疗措施。结果 2013年DCD肾移植丢失率为1. 3%(1/76),2014年早期移植肾丢失率为7. 8%(12/154),2015年早期移植肾丢失率为4. 1%(12/291)。其中移植肾出血(52. 0%)已成为我中心移植肾早期丢失的主要因素,其次为肺部感染(16. 0%)以及心脑血管意外(12. 0%),而原发性移植肾无功能(PNF)和排斥反应仅各占4. 0%,术后早期移植肾感染是早期移植肾出血的主要因素(61. 5%)。结论感染所致的移植肾血管破裂出血是DCD肾移植早期移植肾丢失的主要原因,术前多次供体采样进行微生物学培养及针对性抗感染治疗,对感染高危受者术后进行强化预防性抗感染治疗,有利于降低早期移植肾丢失风险。Objective To analyze the incidence and etiology of early kidney transplant loss from donation after citizen death( DCD) in China and explore the way to prevention and treatment of early graft loss after kidney transplantation. Methods A retrospective review study was implemented to analyze the521 cases of DCD kidney transplantation. The causes of kidney transplantation loss within 3 months after operation were summarized and the preventive and treatment measures were discussed. Results The early renal graft loss rate was 1. 32%( 1/76) in 2013,7. 8%( 12/154) in 2014,4. 1%( 12/291) in 2015. The renal graft rupture and hemorrhage( 52. 0%) had became a main risk of early graft loss,the next risk was lung infection( 16. 0%) and cerebrovascular accident( 12. 0%). However,the primary kidney graft nonfunction( PNF) and rejection only accounted for 4%,respectively. Early postoperative renal transplantation infection was the main factor of early renal transplantation hemorrhage( 61. 5%). Conclusion Effective prevention and prompt treatment for renal graft hemorrhage will significantly reduce the rate of early renal graft loss and improve the prognosis of patients. But also the mediciner should be alert to the occurrence of donor source infection.

关 键 词：公民逝世后器官捐献 肾移植 并发症 供体来源感染 

分 类 号：R699.2[医药卫生—泌尿科学]