扩大标准供者和标准供者供肾异体肾移植术后早期疗效及安全性对比  

Comparison of early curative effect and safety between expanded criteria donor and standard criteria donor allogeneic kidney transplantation

作　　者：雷中杰 李茂[1] 吴凯军 梁思敏[1] LEI Zhongjie;LI Mao;WU Kaijun;LIANG Simin(Department of Urology Surgery,The First Affiliated Hospital of Chongqing Medical University,Chongqing 400016,China)

机构地区：[1]重庆医科大学附属第一医院泌尿外科,重庆400016

出　　处：《重庆医学》2023年第17期2621-2628,共8页Chongqing medicine

基　　金：重庆医科大学附属第一医院学科提升培育项目(2-01-02-03-XKTS1160)。

摘　　要：目的分析扩大标准供者(ECD)和标准供者(SCD)供肾移植后受者早期移植肾功能恢复及术后并发症的差异,为临床ECD供肾移植提供参考。方法回顾性分析2015年1月至2020年12月在该院泌尿外科接受肾移植手术的110例受者,其中接受ECD供肾的受者30例(ECD组),接受SCD供肾的受者80例(SCD组)。比较两组术前基线资料、术后早期血肌酐水平、估算肾小球滤过率(eGFR)及术后并发症发生率,并采用logistic回归模型分析初次肾移植受者术后第6个月出现移植肾功能异常的影响因素。结果对于初次肾移植者:ECD组、SCD组术后急性排斥反应发生率(12.0%vs.7.8%)和移植肾功能延迟恢复发生率(28.0%vs.19.7%)比较,差异均无统计学意义(P>0.05);ECD组、SCD组术后第6个月的移植肾失功发生率分别为4.0%和6.5%,受者移植肾带功死亡率分别为4.0%和1.3%。术后第1个月,两组血肌酐水平无明显差异(P>0.05);术后第3、6个月,ECD组血肌酐水平均高于SCD组,eGFR均低于SCD组,差异有统计学意义(P<0.05)。Nyberg评分是初次肾移植受者术后第6个月出现移植肾功能异常的独立危险因素(OR=1.250,95%CI=1.012~1.544,P=0.039)。结论ECD供肾用于异体肾移植时有较好的疗效和安全性,可作为移植肾的有效来源,且受者Nyberg评分有助于预测肾移植效果。Objective To analyze the differences of early graft renal function recovery and postoperative complications between the recipients after expanded criteria donor(ECD)and standard criteria donor(SCD)allogeneic kidney transportation,in order to provide reference for clinical ECD allogeneic kidney transplantation.Methods A total of 110 recipients who underwent allogeneic kidney transplantation operation at the Department of Urology,the First Affiliated Hospital of Chongqing Medical University,from January 2015 to December 2020 were retrospectively reviewed,including 30 recipients of kidney transplants from ECD(the ECD group)and 80 recipients of kidney transplants from SCD(the SCD group).The preoperative baseline data,early postoperative serum creatinine levels,estimated glomerular filtration rate(eGFR),and postoperative complication rates were compared between the two groups.The logistic regression model was used to analyze the influencing factors of abnormal renal function at the sixth month after the first kidney transplantation.Results There was no significant difference in the incidence of acute rejection(12.0%vs.7.8%)and delayed renal function recovery(28.0%vs.19.7%)between the ECD group and SCD group(P>0.05).The incidence of kidney allograft failure was 4.0%and 6.5%in the ECD group and SCD group at the sixth month after operation,and the mortality rate of recipients with rental function was 4.0%and 1.3%,respectively.There was no significant difference in the serum creatinine level between the two groups at the first month after operation(P>0.05).At the third and sixth month after operation,the serum creatinine level in the ECD group was higher than that in the SCD group,and the eGFR was lower than that in the SCD group,with statistically significant differences(P<0.05).The Nyberg score was an independent risk factor for the occurrence of abnormal renal function at the sixth month after operation(OR=1.250,95%CI:1.012-1.544,P=0.039).Conclusion ECD kidney when used in allogeneic kidney transplantation had relative

关 键 词：同种异体肾移植术 扩大标准供者 标准供者 肾功能 移植肾功能延迟 

分 类 号：R692.5[医药卫生—泌尿科学]