横纹肌溶解合并急性肾损伤供肾移植后受者的临床疗效  

Kidney transplantation from donors with rhabdomyolysis and acute kidney injury

作　　者：袁小鹏[1] 陈传宝[1] 周健[1] 王小平[1] 韩明[1] 郑毅涛[1] 王长希[1] 何晓顺[1] 

机构地区：[1]中山大学附属第一医院东院器官移植三区,广州510700

出　　处：《肾脏病与透析肾移植杂志》2016年第2期124-127,152,共5页Chinese Journal of Nephrology,Dialysis & Transplantation

基　　金：卫生部部属(管)医院临床学科重点项目(2010159);广东省科技计划重点项目(2011A030400005)

摘　　要：目的:探讨横纹肌溶解症合并急性肾损伤(AKI)供者肾移植后受者的临床效果。方法:回顾性分析中山大学附属第一医院2012年1月~2015年12月器官捐献供者中,因横纹肌溶解症导致AKI的供者和肾移植受者临床资料。结果:8例供者因横纹肌溶解症导致AKI,供者血肌酸激酶峰值为10 623±3 692 U/L,血浆肌红蛋白峰值为20 618±7 959μg/L,血清肌酐峰值为483±176μmol/L。其中3例接受血浆置换治疗,2例行持续性肾脏替代治疗(CRRT),1例接受体外膜肺氧合治疗。16例受者,肾移植术后4例移植肾功能延迟恢复,4例移植肾功能缓慢恢复,其余8例受者移植肾功能恢复良好。随访6~46月,人肾均存活。术后6月和12月肾小球滤过率分别为65.4±13.5 ml/(min·1.73m2)和71.2±14.3 ml/(min·1.73m2)。结论:接受横纹肌溶解症合并AKI患者供肾的受者肾移植术后移植肾功能恢复良好。出现AKI的器官捐献供者应该常规行横纹肌溶解症筛查。Objective： To explore the clinical effect of kidney transplantation from donors with acute kidney injury（ AKI） and rhabdomyolysis. Methodology： Kidney transplantation from donors with AKI and rhabdomyolysis from January 2012 to December 2015 was retrospectively reviewed. AKI was defined by RIFLE criteria. Rhabdomyolysis was defined by creatinine kinase（ CK） level higher than five times normal（ 〉1 000 U / L） in conjunction with high serum myoblobin. Results： Eight donors suffered from rhabdomyolysis and AKI with peak CK 10 623 ± 3 692 U / L,peak serum myoblobin 20 618 ± 7 959 μg / L and peak serum creatinine 483 ± 176 μmol / L. Three donors received plasmapheresis therapy（ 1 ~ 2 sessions）,2 donors received continuous renal replacement therapy and 1 donor received extra-corporeal membrane oxygenation treatment. Kidneys from these donors were transplanted into 16 recipients with 4 cases（ 25. 0%） of delayed graft function,4 cases of slow graft function and 8 cases of normal graft function. With a follow-up of 6- 46 months,all patients and renal grafts survived. Mean 6 and 12-month glomerular filtration rate were 65. 4 ± 13. 5 and 71. 2 ± 14. 3m L /（ min·1. 73m^2） respectively. Conclusion： Kidneys from donors with AKI and rhabdomyolysis have excellent shortterm outcomes. Routine Screening for rhabdomyolysis should be recommended in deceased donors with acute renal injury.

关 键 词：肾移植 横纹肌溶解症 急性肾损伤 器官捐献 

分 类 号：R699.2[医药卫生—泌尿科学] R685.5[医药卫生—外科学]