公民逝世捐献与活体捐献肾移植的近期临床效果  

Clinical effects of deceased vs living donor on kidney transplantation

作　　者：潘佳善 苏涌[2] 朱道方[1] 廖贵益[1] PAN Jiashan;SU Yong;ZHU Dao-fang;LIAO Guiyi(Department of Urology,the First Affiliated Hospital of Anhui Medical University,Hefei 230022,China;不详)

机构地区：[1]安徽医科大学第一附属医院泌尿外科四病区,合肥230022 [2]安徽医科大学第一附属医院药剂科,合肥230022

出　　处：《实用医学杂志》2022年第2期184-189,共6页The Journal of Practical Medicine

基　　金：吴阶平医学基金会临床科研专项资助基金青年项目(编号:320.6750.2020-04-39);安徽医科大学基础与临床合作研究提升计划资助项目(编号:2020xkjT030)。

摘　　要：目的阐述单中心公民逝世捐献(deceased donor,DD)与活体捐献(living donor,LD)肾移植的近期临床效果,探讨两种移植类型发生术后并发症的危险因素。方法回顾性分析2017和2018两年内我院接受同种异体肾移植术的254例受者,搜集随访至2021年7月1日的人口统计学和临床资料,分为DD组141例和LD组113例进行统计分析。结果 DD组与LD组在受体性别、受体体质量指数及术前、术后12、24个月的血肌酐值无显著差异。DD组在供体性别、供体年龄、受体年龄、术前透析时间、术后住院时间均显著高于LD组。在预后方面,DD组术后移植肾功能延迟恢复(DGF)发生率、肺部感染发生率、急性排斥发生率、移植肾丢失率(包括移植肾失功和移植肾切除)均显著高于LD组;DD组存活率85.1%低于LD组的96.5%。logistic回归分析表明,DGF的危险因素有"组别类型";肺部感染的危险因素是"组别类型"、"供体年龄"、"受体年龄";以及"组别类型"、"供体年龄"为移植肾失功的危险因素。结论 DD目前虽然是肾脏捐献来源的主流,但本中心及其他中心相关数据表明,其近期临床效果要差于LD,因此要从器官获取、保存、移植等环节提高DD预后情况。进一步分析表明,无论DD还是LD,受体及其匹配的供体术前数据影响着术后DGF、肺部感染、移植肾失功的发生发展。Objective To investigate the clinical outcomes of single-center deceased-donor(DD)versus relative living-donor(LD)on kidney transplantation and to predict the risk factors for postoperative complications.Methods Demographic and clinical data of 254 recipients who underwent allogeneic renal transplantation in our hospital from January 2017 to December 2018 with follow-up to July 2021 were retrospectively analyzed. A total of 141 cases were assigned to the DD group and 113 cases to the LD group for statistical analysis. Results There were no significant differences between the DD group and the LD group in recipient gender,recipient BMI value,preoperative creatinine and blood creatinine values at 12 and 24 month after surgery. The DD group was significantly higher than the LD group in terms of donor gender,age of donors,age of recipients,preoperative dialysis time,and postoperative hospital stay. In terms of surgical prognosis,the incidence of delayed graft function(DGF),pulmonary infection,acute rejection and graft loss(including graft failure and graft nephrectomy)in the DD group were significantly higher than those in the LD group. The survival rate of 85.1% in the DD group was lower than 96.5% in the LD group. Logistic regression analysis showed the risk factors for DGF were group types. The risk factors of pulmonary infection were group type,donor age and recipient age. And group type and donor age were the risk factors for renal graft loss. Conclusions Although DD is the main source of kidney donation at present,relevant data from our center and other centers showed that its short-term clinical effect was worse than that of LD.Therefore,we need to improve the prognosis of DD from the aspects of organ acquisition,preservation and transplantation. Further analysis showed that,regardless of DD or LD,the preoperative demographic status of the recipient or donor also affected the occurrence and development of postoperative DGF,pulmonary infection and renal graft loss,which inspired us to find interventions to impro

关 键 词：逝世捐献 活体捐献 临床效果 肾移植 

分 类 号：R692.5[医药卫生—泌尿科学]