临床肾脏保存2086例经验  

Clinical experience of 2086 cases of kidney preservation

作　　者：何长民[1] 张昊[2] 齐隽[1] 朱有华[1] 闵志廉[1] 

机构地区：[1]第二军医大学长征医院肾脏移植中心,上海200003 [2]解放军第八五医院肾脏科

出　　处：《中华泌尿外科杂志》2003年第3期151-151,共1页Chinese Journal of Urology

摘　　要：目的　总结高渗枸橼酸盐腺嘌呤 (HC A)肾保存液 2 0 86例临床应用经验。　方法　1980年 8月至 2 0 0 0年 12月连续 2 0 86例肾移植 ,供肾采用HC A肾保存液保存。按冷缺血时间分组观察移植后血肌酐 ,移植肾存活率和平均存活时间。　结果　冷缺血时间 <12h(5 73例 )、12～ 2 4h(779例 )和 >2 4h(73 4例 )组移植肾平均存活时间分别为 9.3 2、10 .93和 7.2 3年 ,后者与前两组比较差异均有显著性意义 (P <0 .0 5 ) ;移植后血肌酐、移植肾存活率在各组间差异无显著性意义 (P >0 .0 5 )。约 3 .16%的移植肾因保存问题出现肾功能异常。　结论　应用HC A肾保存液可取得较好的近期肾功能恢复和长期移植肾存活 ,冷缺血时间以 2Objective To summarize the experience of 20 years in using hypertonic citrate adenine (HC A) for clinical kidney preservation. Methods A total of 2 086 cases of kidneys for transplantation from August 1980 to December 2000 were reported.The donors' age ranged from 18 to 49 years.The cadaveric kidneys were harvested with en bloc method,and were perfused via renal arteries with 250 ml HC A at 2～4 ℃ and 100 cm H 2O, and then stored in HC A at 2～4 ℃ throughout preservation.Serum creatinine was measured at 1 week and 1 month after transplantation.Graft survival rates at 1 year and 3,5,10 years and mean graft survival periods were followed up.According to the cold ischemic time,the cases were divided into 3 groups:Group 1, n =573,with cold ischemic time less than 12 h;Group 2, n =779,with 12 to 24 h;and Group 3, n =734,with more than 24 h. Results The mean cold ischemic period of 2 086 cases was (23.68±4.51)h.The mean level of serum creatinine at 1 week and 1 month after transplantation of all cases was (174.5±125.3)μmol/L and (152.5±107.6)μmol/L,without significant differences among the 3 groups.Abnormal renal function at 1 month after transplantation in 66 cases ( 3.16 %) was associated with kidney preservation.There were no differences in graft survival rates at 1 year and 3,5,10 years after transplantation,with graft survival rate at 5 and 10 years in Group 2 reaching 63% and 52%,respectively.The mean graft survival period in Group 3 was significantly less than that in Group 1 and Group 2 ( P <0.05), with 7.23 years in Group 3, 9.32 years and 10.93 years in Group 1 and 2,respectively. Conclusions HC A solution has been used successfully in 2 086 cases of kidney preservation for 20 years, with satisfactory short term graft function and long term graft survival.It should be noted that the preservation period is limited within 24 h in order to obtain optimal outcome.

关 键 词：肾移植 器官保存 保存液 

分 类 号：R699.2[医药卫生—泌尿科学]