成人双肾移植供肾病理评估体系的优化和术式改良  

Optimized pathological evaluation system of donor's kidney and modified surgery during adult dual kidney transplantation

作　　者：张利民[1] 侯帅恒 彭宣 倪海强 吴喜红 陈剑霖 郭晖[1] 施辉波[1] 蒋继贫[1] 明长生[1] 卢峡[1] 宫念樵[1] Zhang Limin;Hou Shuaiheng;Peng Xuan;Ni Haiqiang;Wu Xihong;Chen Jianlin;Guo Hui;Shi Huibo;Jiang Jipin;Ming Changsheng;Lu Xia;Gong Nianqiao(Institute of Organ Transplantation,Tongji Hospital,Tongji Medical College,Huazhong University of Science and Technology,Key Laboratory of Organ Transplantation,Ministry of Education,NHC Key Laboratory of Organ Transplantation,Key Laboratory of Organ Transplantation,Chinese Academy of Medical Sciences,Wuhan 430030,China)

机构地区：[1]华中科技大学同济医学院附属同济医院器官移植研究所,器官移植教育部重点实验室,国家卫生健康委员会器官移植重点实验室,中国医学科学院器官移植重点实验室,武汉430030

出　　处：《中华器官移植杂志》2022年第4期199-204,共6页Chinese Journal of Organ Transplantation

基　　金：国家自然科学基金(82170772);华中科技大学同济医学院研究型临床医师(优先资助)(5001540015)。

摘　　要：目的探讨优化的供肾病理评估体系和改良的术式在成人双肾移植(DKT)中的安全性、可行性,并评估其疗效,以期为扩大标准的供者供肾移植提供更多可供选择的方案。方法回顾性分析2019年6月至2021年5月期间在华中科技大学同济医学院附属同济医院实施的10例按照统一标准实施的成人DKT临床资料,男性8例,女性2例;年龄为(57.9±12.8)岁;体重指数(BMI)为(24.1±4.1)kg/m^(2);捐献类型中心脏死亡7例,脑死亡3例;获取前血肌酐为107.6(93.3,163.5)μmol/L。所有双供肾均行零点穿刺活检,通过结合Banff标准和Remuzzi评分,优化病理评估体系进行评分,结果提示肾小球硬化左肾为2.0(1.5,2.0)、右肾为1.5(1.0,2.0);Remuzzi评分左肾为(4.4±1.2)分、右肾为(3.6±1.5)分。10例成人DKT受者中,全部为男性;年龄为(43.1±9.0)岁;BMI为(22.2±1.9)kg/m^(2);术前群体反应性抗体(PRA)均为阴性。结果10例受者均采用改良的术式,双肾置于髂血管外侧,采用不带瓣方案,上方肾脏的肾动脉首选与髂内动脉吻合,手术时间为(195±54.3)min;出院时血肌酐为125.0(102.0,199.0)μmol/L,肾动态显像结果提示肾小球滤过率左肾(30.0±8.2)ml/min、右肾(29.2±13.9)ml/min,磁共振血管造影结果提示移植肾动、静脉走行规则;手术至出院时间为(22.4±4.7)d。与同期单肾移植(SKT)比较,DKT出院时血肌酐低于SKT,移植物功能延迟(DGF)发生率高于SKT,但差异无统计学意义;DKT手术至出院时间长于SKT(P<0.05)。术后并发症中供者来源感染(DDI)2例、DGF 5例,未发生血管和输尿管等手术相关并发症。术后随访6个月,10例受者肾功能维持稳定,无显著波动。结论优化的供肾病理评估体系和改良的肾移植术式应用于成人DKT中,其安全性较高、实施的可行性较好,术后移植双肾功能恢复顺利,但仍需长期随访并评估其疗效。Objective To explore the safety and feasibility of optimized pathological evaluation system of donor's kidney and modified surgery during adult dual kidney transplantation(DKT)and evaluate its effectiveness to provide more alternative protocols for kidney transplantation from extended criteria donors.Methods DKT was performed in 10 recipients using the same protocol from June 2019 to May 2021.And retrospective reviewing was performed for clinical data,including characteristics of donors and recipients,optimized pathological evaluation system,modified surgery,treatment regimens,complications and follow-ups.Results There were 8 male and 2 female donors with an age of(57.9±12.8)years and BMI(24.1±4.1)kg/m^(2).The percentage of DCD was 70%and DBD 30%.The serum creatinine before procurement was 107.6(93.3-163.5)μmol/l.Zero-point puncture biopsy was performed for both kidneys and optimized pathological evaluation system was implemented(Banff criteria&Remuzzi score).The pathological results indicated that glomerular sclerosis for left and right kidneys were 2.0(1.5-2.0)and 1.5(1.0-2.0).And Remuzzi score for left and right kidneys were(4.4±1.2)and(3.6±1.5)points respectively.All recipients were male with an age of(43.1±9.0)years and BMI(22.2±1.9)kg/m^(2).All PRAs were negative pre-operation.Modified surgery was performed in all recipients(two kidneys were implanted outside iliac vessels without patch and artery of superior kidney was anastomosed to internal iliac artery).Operative duration was(195±54.3)min and serum creatinine before discharge 125.0(102.0-199.0)μmol/L.Renal dynamic scintigraphy indicated that glomerular filtration rate was(30.0±8.2)ml/min for left kidney and(29.2±13.9)ml/min for right kidney.MRA results indicated that morphologies of renal arteries and veins were regular.The time between operation and discharge was(22.4±4.7)days.Compared with SKT,serum creatinine before discharge of DKT was lower and DGF incidence of DKT was higher without statistical significance.The time between operation a

关 键 词：肾移植 边缘供肾 肾穿刺活检 

分 类 号：R699.2[医药卫生—泌尿科学]