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纸质出版:2015
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刘斌,曾凡军,陈知水,蒋继贫,明长生,张伟杰,陈刚.心脏死亡器官捐献供者肾移植的近期效果评价[J].陆军军医大学学报(原第三军医大学学报),2015,37(01):64-68.
Liu Bin,Zeng Fanjun,Chen Zhishui,Jiang Jipin,Ming Changsheng,Zhang Weijie,Chen Gang.Short-term outcome of kidney allograft transplantation from the deceased cardiac donors[J].J Amry Med Univ (J Third Mil Med Univ),2015,37(01):64-68.
刘斌,曾凡军,陈知水,蒋继贫,明长生,张伟杰,陈刚.心脏死亡器官捐献供者肾移植的近期效果评价[J].陆军军医大学学报(原第三军医大学学报),2015,37(01):64-68. DOI:
Liu Bin,Zeng Fanjun,Chen Zhishui,Jiang Jipin,Ming Changsheng,Zhang Weijie,Chen Gang.Short-term outcome of kidney allograft transplantation from the deceased cardiac donors[J].J Amry Med Univ (J Third Mil Med Univ),2015,37(01):64-68. DOI:
目的 比较心脏死亡器官捐献(donor after cardiac death
DCD)供肾移植和司法途径标准供者(standard criteria donors,SCD)肾移植的近期存活效果。 方法 回顾性分析2013年1-9月施行的尸体供肾移植89例,其中DCD供肾移植(DCD组)56例,SCD供肾移植(SCD组)33例。DCD组供肾采用低温机器灌注保存(HMP)25例,单纯低温保存31例;SCD组供肾全部采用单纯静态低温保存。DCD组采用抗体诱导+他克莫司(TAC)+麦考酚酯(MMF)+泼尼松(Pred)四联免疫抑制方案,SCD组采用TAC+MMF+Pred三联用药。随访评价2组移植肾6个月、1年存活率与受者6个月、1年存活率;移植肾功能延迟恢复(delayed graft function
DGF)发生率以及肾功能状况。 结果 随访6~15个月。DCD组受者因肺部感染死亡1例,因假性肾动脉瘤和急性体液性排斥反应导致移植肾切除各1例,受者6个月存活率98.2%,1年存活率94.4%,移植肾6个月存活率94.6%,1年存活率83.3%;SCD组因肺部感染死亡1例,AMR导致移植肾切除1例,受者6个月存活率97.0%,1年存活率92.9%,移植肾6个月存活率93.9%
1年存活率85.7%。2组受者6个月与1年存活率及移植肾6个月与1年存活率差异均无统计学意义(P0.05)。DGF发生率DCD组为21.4%,SCD组18.2%,差异无统计学意义(P=0.20)。术后1、3、6、12个月血肌酐值,DCD组均显著高于SCD组(P0.05),但是2组间估算肾小球滤过率在各时间点差异均无统计学意义(P0.05)。 结论 DCD供肾移植近期存活效果良好,术后肾功能恢复和维持情况与司法途径SCD供肾移植相当,DCD可以成为扩大尸体肾移植供者池的重要来源,其远期存活效果需要继续随访观察。
Objectives Organ donation after deceased cardiac donors (DCD) will be the major sources of donor pool in kidney transplantation in China. We compared early outcomes in kidney transplants from DCD versus the standard criteria donors (SCD). Methods Eighty-nine recipients of adult deceased donor kidney transplantion in our institute from January to September 2013 were subjected in this study
and retrospectively analyzed. There were 56 cases receiving from DCD and 33 from SCD. DCD kidneys were perfused either by Lifeport hypothermic mechanic pump (n=25) or by static hypothermic storage (n=31). SCD kidneys were all perfused by static hypothermic storage. The recipients in DCD group received antibody induction therapy combined with tacrolimus (TAC)
mycophenolatemofetil (MMF)
and tapering doses of prednisone. While
the recipients in SCD group were treated with TAC-based triple-combined maintenance immunosuppressive agents. They were all followed up for 6 to 15 months. The incidence of delayed graft function (DGF)
and patient and graft survival outcomes were observed and compared between the 2 groups. Results In the DCD group
there was 1 case died of lung infection though with normal renal function
1 case having transplant nephrectomy due to renal artery pseudo-aneurysm and acute humoral rejection (AMR). The 6-month survival rate of recipients was 98.2%
and 1-year survival rate was 94.4%
while graft survival rate was 94.6% in 6 month and 83.3% in 1 year. As for SCD group
1 patient died of lung infection
and 1 had transplant nephrectomy because of AMR. The 6-month survival rate of recipients was 97.0%
and 1-year survival rate was 92.9%. The graft survival rate was 93.9% in 6 months
and 85.7% in 1 year. There was no significant difference in the 6-month and 1-year survival rates for the receipts and for the grafts (P0.05). The incidence of DGF was 21.4% and 18.2% respectively for the DCD and SCD groups
without significant difference (P=0.20). Though the 1-
3-
6-
and 12-month serum creatinine (SCr) levels were obviously higher in the DCD group than the SCD group
no difference was found in estimated glomerular filtration rate (eGFR) by simplified MDRD equation (P0.05). Conclusion The recipients of DCD kidneys have similar early survival outcome as those of SCD kidneys. It suggests that the use of DCD kidneys may be a suitable strategy to expand the donor pool. But long-term survival should be explored in further follow-up.
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