接受公民逝世后器官捐献肾移植的临床疗效评价  

Clinical outcome of kidney transplantation from donation after citizen’s death

作　　者：王锁刚[1] 卢鹏 何伟 翟琼瑶 王帝[1] 陈铸[1] 迟凯凯[1] 王光策[1] WANG Suogang;LU Peng;HE Wei;ZHAI Qiongyao;WANG Di;CHEN Zhu;CHI Kaikai;WANG Guangce(Department of Urology and Kidney Transplantation,the First Affiliated Hospital of Henan University of Traditional Chinese Medicine,Zhengzhou,Henan 450003,China)

机构地区：[1]河南中医药大学第一附属医院泌尿外肾移植科,郑州450003

出　　处：《肾脏病与透析肾移植杂志》2020年第3期232-236,共5页Chinese Journal of Nephrology,Dialysis & Transplantation

基　　金：河南省重点研发与推广专项(科技攻关)(182102310247)。

摘　　要：目的:分析接受公民逝世后器官捐献(DCD)肾移植的临床疗效,评价DCD供肾质量与肾移植受者的预后和转归.方法:回顾性研究DCD供者和肾移植受者的临床资料,观察供肾质量评分、肾移植受者肾功能恢复情况、围手术期并发症、移植肾功能延迟恢复(DGF)和移植肾丢失的发生率与长期随访情况.结果:成功实施DCD 114例,供肾热缺血时间(5.6±2.2)min,冷缺血时间(6.5±1.6)h;非边缘性供肾(A级+B级)占92.11%,边缘性供肾(C级+D级)占7.89%;供肾获取、灌注、保存及修复过程顺利.228例终末期肾病患者成功接受DCD供肾肾移植手术,其中211例受者围手术期恢复顺利,术后6~14d肾功能恢复正常;术后DGF的发生率为3.54%(8/228),术后20~45 d肾功能逐渐恢复;1例受者移植肾原发性无功能和3例受者移植肾动脉破裂出血切除了移植肾,围手术期移植肾丢失率为1.75%(4/228);无一例受者围手术期死亡.随访过程中213例受者肾功能稳定,8例受者发生移植肾功能衰竭,3例受者死亡.结论:DCD供肾肾移植的总体临床疗效良好,但仍存在潜在风险和并发症.Objective:To analyze clinical outcome of kidney transplantation from organ donation after citizen′s death(DCD),and to evaluate quality of DCD kidney and prognosis of kidney transplantation recipients. Methodology:The clinical data of DCD donors and kidney transplant recipients were retrospectively studied to observe the quality score of donor kidney,kidney function recovery,perioperative complications,delayed graft function(DGF), incidence of perioperative graft loss and long-term follow-up. Results:The 114 cases of DCD were successfully administered,with warm ischemia time(5.6±2.2) min and cold ischemia time(6.5±1.6) h.Non-marginal donors(grade A+B) accounted for 92.11%,while marginal donors(grade C+D) accounted for 7.89%.The donor kidney was successfully obtained,perfused,preserved and repaired.Among 228 patients with end stage kidney disease who received DCD donor kidney transplantation,211 of them recovered successfully during the perioperative period,and their renal function returned to normal 6~14 days after surgery.The incidence of DGF was 3.54%(8/228),and renal function gradually recovered and discharged from hospital 20~45 days after surgery.The graft was removed in 1 primary non-functional recipient and 3 recipients with renal artery rupture and hemorrhage,the perioperative graft loss rate was 1.75%(4/228).None of the recipients died perioperatively.During the follow-up,213 recipients have stable graft renal function,8 recipients have graft renal failure,and 3 recipients died. Conclusion:The overall clinical outcome of DCD donors for kidney transplant is good,but there are still some risks and complications.

关 键 词：公民逝世后器官捐献 肾移植 临床疗效 

分 类 号：R699.2[医药卫生—泌尿科学]