CAJ | 학술논문

目的评估活体亲属供肾移植的安全性和效果. 方法回顾性分析2003年11月至2006年9月30例活体亲属供肾移植的临床资料.其中夫妻间供肾移植2例,直系血缘亲属供肾移植28例.供受体间2条单倍体相同6例、1条单倍体相同22例;HLA全错配1例,4抗原错配1例.供体切取右肾7例、左肾23例,经腹部取肾5例、经腰部25例,均为开放手术取肾.受体再次移植2例,首次移植28例. 结果 30例供体取肾术后7～10 d出院,随访3～6个月,肾功能正常.30例受体中1例因移植肾功能延迟恢复、肺部感染死亡.术后发生排斥反应4例,1例经抗胸腺淋巴细胞球蛋白逆转,3例经甲泼尼龙冲击治疗逆转.术后发生移植肾肾周血肿再次手术止血1例;发生尿瘘2例,均经保守治疗痊愈.29例存活者随访1～4年,其中术后1年发生慢性移植物失功1例,移植肾功能正常28例. 结论活体亲属供肾移植安全,效果良好,供肾热缺血时间短、组织配型好、排斥反应小、免疫抑制剂用量少、长期存活率高,应积极提倡和推广.
목적 평고활체친속공신이식적안전성화효과. 방법 회고성분석2003년11월지2006년9월30례활체친속공신이식적림상자료.기중부처간공신이식2례,직계혈연친속공신이식28례.공수체간2조단배체상동6례、1조단배체상동22례;HLA전착배1례,4항원착배1례.공체절취우신7례、좌신23례,경복부취신5례、경요부25례,균위개방수술취신.수체재차이식2례,수차이식28례. 결과 30례공체취신술후7～10 d출원,수방3～6개월,신공능정상.30례수체중1례인이식신공능연지회복、폐부감염사망.술후발생배척반응4례,1례경항흉선림파세포구단백역전,3례경갑발니룡충격치료역전.술후발생이식신신주혈종재차수술지혈1례;발생뇨루2례,균경보수치료전유.29례존활자수방1～4년,기중술후1년발생만성이식물실공1례,이식신공능정상28례. 결론 활체친속공신이식안전,효과량호,공신열결혈시간단、조직배형호、배척반응소、면역억제제용량소、장기존활솔고,응적겁제창화추엄.
Objective To evaluate the safety and feasibility and clinical effectiveness of living relative donor kidney transplantation(LDKT)and summarize its clinical experience. Methods The clinical data of 30 cases of LDKT were retrospectively analyzed.Except for 2 cases being donated by spouse,the others were donated by blood relative donors.6 cases shared two haplotypes,and 22 cases shared one haplotype,and one case 4 mismatched,and 1 fully mismatched.All donors underwent open nephroectomy,in which 7 cases donated right kidneys and 23 donated left kidneys.In 30 cases of recipients,1 case received cadaver donor kidney transplantation and lost her allograft because of superacute rejection.Triple-combined immunosuppressive protocols consisted of calcineurin inhibitor (CNI),mycophenolate mofetil(MMF)or azathioprine(AZa)and steroid. Results All donors'hospital stay was 7 to 10 days postoperatively without any surgical complications. All donors kept their normal kidney function within 3 to 6 months'follow-up.Except for 1 case of death because of lung in fection,29 cases of recipients survived,in which 28 cases kept their normal function kidney within 1 to 4 years of follow-up and 1 case occurred chronic allograft nephropathy after one year.Except one case of DGF,29 cases of recipients retained their normal kidney function in 3 to 5 days postoperatively.Rejection episodes occurred in 4 cases,of which 3 cases were reversed by methylprednisone and 1 case by antithymocyte globulin(ATG)and Tacrolimus.Pneumonia developed in 3 cases,of which 2 cases were cured and 1 case failed.Hematoma was found around allograft in 1 case and wag surgi cally removed.Urinary leakage was happened in 2 cases of recepients and were cured by conservative treatment. Conclusions LDKT is safe and feasible with good long-term results and more advantages such as optimal HLA matches and less ischemia time and lower acute rejection,low-dose immunosup pressants.