成人供肾双肾移植疗效分析  

Analysis of outcomes in adult deceased donor dual kidney transplantation

作　　者：赵大强 张利民[1] 宫念樵[1] 刘斌[1] 陈刚[1] 蒋继贫[1] 施辉波[1] 昌盛[1] 陈松[1] 朱兰[1] 杜敦锋 余陈真 吕春辉 潘梓文 陈知水[1] 张伟杰[1] Zhao Daqiang;Zhang Limin;Gong Nianqiao;Liu Bin;Chen Gang;Jiang Jipin;Shi Huibo;Chang Sheng;Chen Song;Zhu Lan;Du Dunfeng;Yu Chenzhen;Lyu Chunhui;Pan Ziwen;Chen Zhishui;Zhang Weijie(Department of Organ Transplantation,Tongji Hospital,Tongji Medical College,Huazhong University of Science and Technology,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 510030,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科、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510030

出　　处：《中华医学杂志》2025年第5期364-370,共7页National Medical Journal of China

基　　金：国家自然科学基金(82170774);湖北省重点研发计划(2022BCA015,2023BCB010)。

摘　　要：目的探讨成人供肾双肾移植(DKT)的疗效。方法回顾性纳入2015年3月至2024年6月华中科技大学同济医学院附属同济医院器官移植研究所成人供肾DKT的供者和受者的临床资料,随访至2024年9月。总结供受者、供肾、手术方式、并发症及随访等临床资料,分析5年内移植肾功能和受者/移植肾存活率。结果共纳入102对DKT供、受者。供者男83例,女19例,年龄(57.8±11.1)岁,体质指数(BMI)为(23.1±3.2)kg/m^(2);受者男95例,女7例,年龄(42.0±11.0)岁,BMI为(22.1±3.1)kg/m^(2)。受者术后住院和随访时间[M(Q_(1),Q_(3))]分别为[20.0(15.0,27.0)]d和[30.0(12.5,49.0)]个月。供者捐献类型中64.7%(66/102)为中国Ⅱ类捐献。供肾获取前供者血清肌酐(Scr)为[97.0(66.5,144.5)]μmol/L。低温机械灌注使用率为52%(53/102)。供肾热缺血时间为(5.5±1.7)min,冷缺血时间为(8.7±3.8)h。左、右供肾移植前Remuzzi评分分别为(4.8±1.3)、(5.1±1.4)分;肾小球硬化率分别为34.0%±16.2%、35.3%±16.7%。80.3%(82/102)的受者原发肾病不详,8.8%(9/102)的受者原发肾病为IgA肾病。将双肾植入在受者同侧的占比为94.1%(96/102),手术时间为(5.3±1.4)h。74.5%(76/102)的受者使用淋巴细胞清除剂免疫诱导。术后有1例受者发生原发移植物无功能。移植物功能延迟恢复和排斥发生率分别为30.4%(31/102)和9.8%(10/102)。总体手术并发症发生率为10.8%(11/102)。术后1、3、5年受者存活率分别为100.0%、98.3%、98.3%;术后1、3、6个月和1、3、5年移植肾存活率分别为97.1%、96.1%、95.0%和94.0%、89.3%、85.6%。受者5年内移植肾功能保持稳定。5年时受者Scr和估算肾小球滤过率(eGFR)分别为153.0(120.0,232.0)μmol/L和(42.1±17.1)ml·min^(-1)·(1.73 m^(2))^(-1)。结论成人供肾DKT近期及5年疗效较好。Objective:To investigate the efficacy of dual kidney transplantation(DKT)from adult donors.Methods:Clinical data of adult DKT donors and recipients in the Institute of Organ Transplantation,Tongji Hospital,Tongji Medical College,Huazhong University of Science and Technology from March 2015 to June 2024 were retrospectively analyzed.The patients were followed up until September 2024.The clinical data of donor and recipient,donor kidney,surgical techniques,complications,and follow-up were collected.Transplant renal function and recipient/graft survival rates within 5 years were analyzed.Results:A total of 102 pairs of DKT donors and recipients were included.Among the donors,83 were male and 19 were female,with age of(57.8±11.1)years and body mass index(BMI)of(23.1±3.2)kg/m^(2).Among the recipients,95 were male and 7 were female,with age of(42.0±11.0)years and BMI of(22.1±3.1)kg/m^(2).The postoperative hospitalization and follow-up duration[M(Q_(1),Q_(3))]for recipients were[20.0(15.0,27.0)]days and[30.0(12.5,49.0)]months,respectively.China ClassⅡdonation accounted for 64.7%(66/102)of donor categories.The pre-procurement serum creatinine(Scr)level of donors was[97.0(66.5,144.5)]μmol/L,and the hypothermic machine perfusion utilization rate was 52%(53/102).The warm ischemia time was(5.5±1.7)minutes,and the mean cold ischemia time was(8.7±3.8)hours.The Remuzzi scores for the left and right kidneys before transplantation were(4.8±1.3)and(5.1±1.4)scores,respectively.The glomerulosclerosis rates for the left and right kidneys were 34.0%±16.2%and 35.3%±16.7%,respectively.The primary nephropathy was unknown in 80.3%(82/102)of recipients,and IgA nephropathy was diagnosed in 8.8%(9/102)of the recipients.Bilateral kidneys were implanted ipsilaterally in 94.1%(96/102)of recipients,with operative time of(5.3±1.4)hours.Lymphocyte-depleting induction therapy was administered to 74.5%(76/102)of recipients.One recipient experienced primary graft non-function after surgery.The incidences of delayed graft function and re

关 键 词：肾移植 双肾移植 边缘供肾 并发症 存活率 

分 类 号：R699.2[医药卫生—泌尿科学]