单中心脑-心双死亡供肾肾移植及免疫方案经验总结  

Kidney transplantation from brain and cardiac death donors and immunosuppression： a single -center experience

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

机构地区：[1]佛山佛山市第一人民医院肾内科,广东528000

出　　处：《国际泌尿系统杂志》2018年第3期412-415,共4页International Journal of Urology and 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 探讨脑-心双死亡（donation after brain plus cardiac death,DBCD）供肾肾移植的经验及免疫抑制方案的有效性.方法 回顾性分析本院2011年9月至2015年8月完成的80例受者临床资料,所有受者均采用双剂量巴利昔单抗免疫诱导治疗,术后均使用泼尼松、吗替麦考酚酯分散片和他克莫司胶囊抗排斥治疗,随访1年,统计术后急性排斥、肾功能延迟恢复（delayed graft function,DGF）、人肾存活、并发症情况,对不良事件及实验室异常结果进行评估.结果 80例受者在第1、3、6、12个月生存率分别为100.0％（100/100）、100.0％ （100/100）、98.7％（79/80）、97.5％（78/80）,移植肾存活率分别为97.5％（78/80）、97.5％（78/80）、96.2％（77/80）、95.0％（76/80）,80例受者发生肾功能延迟恢复（DGF） 13例,发生率16.3％,DGF组与无DGF组患者生存率及移植肾存活比较,差异无统计学意义（P=0.525、P=0.372）,急性排斥患者5例,发生率6.3％,所有患者均未发生原发性移植肾无功能,围手术期泌尿系感染受者5例、带状疱疹感染受者2例、腹腔感染受者2例.结论 DBCD是解决我国器官短缺的重要手段,为扩大供肾来源开辟了新途径,以双剂量巴利昔单抗为免疫诱导方案联合泼尼松、吗替麦考酚酯分散片、他克莫司胶囊免疫抑制方案能有效较少急性排斥反应的发生率,安全性与耐受性较好.Objective To investigate the experience of kidney transplantation from brain and cardiac death donors（donation after brain plus cardiac death,DBCD）and clinical effect of immunosuppressive regimen.Methods A retrospective analysis of kidney transplantation from DBCD in our hospital from September 2011 to August 2015 was performed.All patients were treated with double doses Basiliximab to inductive immune,and then treated with prednisone （Pre）,mycophenolate mofetil （MMF）,Tacrolimus （FK506）.During the follow-up of 1 year,acute rejection,incidence of delayed graft function （DGF）,patient＇s survival and graft survival rates,complication and clinical adverse events and laboratory test results were evaluated.Results In the 80 cases,the actuarial patient and grafts＇survival rates at 1,3,6 and 12 months after transplantation was 100.0% （100/100）,100.0% （100/100）,98.7% （79/80）,97.5% （78/80） and 97.5% （78/80）,97.5% （78/80）,96.2%（77/80）,95.0% （76/80） respectively.DGF occurred in 13 of 80 （16.3%）,but the occurrence of DGF did not adversely influence patient＇s survival （P =0.525） or graft survival （P =0.372）.Five cases of acute rejection appeared（6.3%）and the primary non-functioning kidney was not occurred in all patients.Five cases of urinary tract infection during perioperative period,abdominal infection in 2 cases,herpes simplex infection in 2 cases were found.Conclusions DBCD is an important means to solve the shortage of organs in our country,it opens up a new way to expand the source of donor kidney.The combined use of two doses of Basiliximab for inductiving immune combination with Pre,MMF,FK506 immunosuppressive regimen can effctively reduce the incidence of acute rejection,the safety and tolerance are better.

关 键 词：肾移植 脑死亡 免疫疗法 

分 类 号：R699.2[医药卫生—泌尿科学]