CAJ | 학술논문

目的探讨活体肾移植供肾肾小球滤过率( GFR)对受体早期肾功能的影响.方法 2006年至2011年在本中心接受活体肾移植172例为研究对象,其中亲属供肾166例(96.5％),夫妻供肾5例(2.9％),帮扶供肾1例(0.6％).术前应用放射性核素99mTC-DTPA肾动态显像测定供体左右肾GFR.供体的双肾GFR为62～148 ml/min,将对象分为供肾GFR≤45ml/min受体76例和供肾GFR＞45 ml/min 96例.两组受体的透析情况、冷、热缺血时间、抗体诱导及免疫抑制方案、HLA错配率等基本资料相似.评价患者术后早期肾功能变化情况.结果两组患者术后急性排斥反应以及肾功能延迟恢复( DGF)发生率差异无统计学意义.与供肾GFR≤45 ml/min组比较,供肾GFR＞45 ml/min组的Scr在术后1周、1个月、3个月、1年均较低,其中术后1周的差异有统计学意义(P＜0.05)；术后1个月、3个月、1年的差异均无统计学意义.重复测量的方差分析显示术后1年内两组受体Scr变化差异无统计学意义.结论活体肾移植供肾GFR高低对受体术后1周Scr下降水平有影响,供肾GFR高者受体术后1周Scr水平低,但是对受体术后早期(1年内)的Scr整体水平及变化趋势无显著影响.
목적 탐토활체신이식공신신소구려과솔( GFR)대수체조기신공능적영향.방법 2006년지2011년재본중심접수활체신이식172례위연구대상,기중친속공신166례(96.5％),부처공신5례(2.9％),방부공신1례(0.6％).술전응용방사성핵소99mTC-DTPA신동태현상측정공체좌우신GFR.공체적쌍신GFR위62～148 ml/min,장대상분위공신GFR≤45ml/min수체76례화공신GFR＞45 ml/min 96례.량조수체적투석정황、랭、열결혈시간、항체유도급면역억제방안、HLA착배솔등기본자료상사.평개환자술후조기신공능변화정황.결과 량조환자술후급성배척반응이급신공능연지회복( DGF)발생솔차이무통계학의의.여공신GFR≤45 ml/min조비교,공신GFR＞45 ml/min조적Scr재술후1주、1개월、3개월、1년균교저,기중술후1주적차이유통계학의의(P＜0.05)；술후1개월、3개월、1년적차이균무통계학의의.중복측량적방차분석현시술후1년내량조수체Scr변화차이무통계학의의.결론 활체신이식공신GFR고저대수체술후1주Scr하강수평유영향,공신GFR고자수체술후1주Scr수평저,단시대수체술후조기(1년내)적Scr정체수평급변화추세무현저영향.
Objective To study the influence of donor GFR on the early renal function in recipients undergoing living donor transplantation.Methods A total of 172 living donor transplant recipients in our kidney transplantation center from 2006 to 2011 were enrolled into this study.Among them,166 were genetically related (96.5％),while 6 were genetically unrelated (spouses in 5 and other in 1).The predonation GFR was measured by isotope clearance (99mTC-DTPA with few exceptions).The range of donor GFR was 62 to 148 ml/min.The recipients were classified into two groups according to donor graft GFR level (GFR≤45 ml/min,n=76; GFR＞45 ml/min,n =96).The predonation dialysis,cold and warm ischemia time,antibody induction,immunosuppressive regimens and HLA mismatch were not significantly different between two groups.Results There were no significant differences in the incidence of postoperative acute rejection and delay graft function (DGF).The postoperative Scr of GFR＞45 ml/min group in 1 week,1 month,3 months and 1 year was lower compared with the GFR ≤45 ml/min group,and only the difference of Scr in 1 week was significantly different (P＜0.05).A repeated-measure ANOVA revealed no significant differences were found in Scr variation of two groups during the first year after transplantation.Conclusions Predonation GFR of the donor has effect on the Scr of postoperative Ⅰ week of recipients,not on the Scr within a year.Recipients with graft GFR＞45 ml/min have lower Scr levels.