活体肾移植供者留存肾不同肾小球滤过率水平对供者长期安全性的评价  

Long-term donor safety for different levels of glomerular filtration rate of retained kidney in living-related renal transplantation

作　　者：豆猛 郑秉暄 韩锋[1] 丁晨光[1] 潘晓鸣[1] 丁小明[1] 项和立[1] 任莉[1] 薛武军[1] 田普训[1] Dou Meng;Zheng Bingxuan;Han Feng;Ding Chenguang;Pan Xiaoming;Ding Xiaoming;Xiang Heli;Ren Li;Xue Jianjun;Tian Puxun(Department of Kidney Transplantation,Division of Kidney Diseases,First Affiliated Hospital,Xi'an Jiaotong University School of Medicine,Institute of Organ Transplantation,Xi'an Jiaotong University,Xi'an 710061,China)

机构地区：[1]西安交通大学第一附属医院肾脏病医院肾移植科,西安交通大学器官移植研究所,710061

出　　处：《中华器官移植杂志》2020年第10期583-587,共5页Chinese Journal of Organ Transplantation

基　　金：国家自然科学基金(81870514,82070768);陕西省自然科学基金(2017ZDJC-09);西安交通大学第一附属医院临床研究课题(XJTU1AF-CRF-2019-008);中国器官移植发展基金会"菁英计划"项目(2019JYJH04)。

摘　　要：目的探讨活体肾移植留存肾不同肾小球滤过率(GFR)水平对供者术后肾功能恢复、并发症及长期健康的影响。方法收集西安交通大学第一附属医院1999年10月19日至2018年12月31日512例活体肾移植供者的临床资料。术前应用放射性核素99mTC-DTPA肾动态显像法测定供者左、右肾GFR,根据供者术前留存肾GFR结果,将供者分为GFR<45 ml/min组111例(其中12例供者留存肾GFR为35~40 ml/min),45 ml/min≤GFR<50 ml/min组91例和GFR≥50 ml/min组147例。评价供者术后肾功能恢复、并发症及长期健康情况。结果根据随访情况,512例供者中163例因资料不完整排除,349例供者纳入本研究,供者随访时间为1.0~20.0年,中位随访时间为8.3年。所有随访供者均健康存活,术后无慢性肾脏病和终末期肾脏病(ESRD)发生。三组供者术后高血压及尿蛋白的发生率差异无统计学意义(P>0.05)。与留存肾GFR<45 ml/min组相比,留存肾GFR≥50 ml/min组的血清肌酐水平在术后3d、1周、3个月、1年、3年、5年、10年均略低,估算肾小球滤过率(eGFR)较高,术后3d、1周、3个月的差异有统计学意义(P<0.05),术后1年、3年、5年、10年以上的差异无统计学意义(P>0.05),留存肾GFR<45 ml/min组与留存肾45 ml/min≤GFR<50 ml/min组相比,差异无统计学意义(P>0.05)。三组供者术后10年以上的GFR(99mTC-DTPA肾动态显像法测定)差异无统计学意义(P>0.05)。结论活体肾移植供者术后长期安全性良好。对于术前总GFR≥80 ml/min的供者,留存肾GFR影响供者早期肾功能水平,留存肾GFR高的供者术后早期(3个月内)血肌酐水平较低、eGFR水平较高,但留存肾GFR水平不影响供者术后远期肾功能及并发症发生率。Objective To explore the long-term safety for different levels of glomerular filtration rate(GFR)of retained kidney among living-related donors.Methods From 1999 to 2018,a total of 512 living donors were recruited and divided into three groups according to the GFR level of donor retained kidney(GFR<45 ml/min;45 ml/min≤GFR<50 ml/min;GFR≥50 ml/min).Health status,postoperative recovery and postoperative complications were compared.GFR was measured by 99mTC-DTPA.The recovery of kidney function and postoperative complications of donor were evaluated.Results After excluding 163 donors because of incomplete data,a total of 349 healthy donors without kidney failure were included.The longest postoperative follow-up time was 20 years and the median follow-up period 8.3 years.No significant difference existed in the incidence of postoperative hypertension and urinary protein among three donor groups.The postoperative serum level of creatinine(Scr)at Week 1,Month 1/3 and Year 3/5/10 was higher in GFR≥50 ml/min group than that in GFR<45 ml/min group and the differences of Scr/eGFR were significantly different at Week 1 and Month 3(P<0.05).And GFR was not significantly different among three donor groups beyond 10 years.Conclusions Living-related donors have excellent long-term safety after donation.For donors with preoperative total GFR≥80 ml/min,the level of retained renal GFR affects early renal function recovery while those with high GFR recover faster postoperatively.However,GFR level does not affect long-term donor renal function and complication rate after donation.

关 键 词：肾移植 肾小球滤过率 供者 

分 类 号：R699.2[医药卫生—泌尿科学]