CAJ | 학술논문

目的探讨高血压脑出血致心死亡者供肾移植的效果.方法回顾分析14例高血压脑出血致心死亡者(高血压脑出血供者)、19例脑外伤致心死亡者(脑外伤供者)的供肾资料,以及接受其供肾移植的受者资料,供者符合中国二类或三类标准,且均为标准供者,其中接受高血压脑出血者供肾移植27例(脑出血供者组),接受脑外伤者供肾移植38例(脑外伤供者组).高血压脑出血者的供肾均采用机器灌注保存,脑外伤者的供肾有8例采用机器灌注保存.两组的免疫抑制方案相同.分析高血压脑出血供者供肾移植的效果,并与脑外伤供者供肾移植相比较.结果高血压脑出血供者的最大肌酐清除率为(86.6±19.5)ml/min,显著低于脑外伤供者的(129.6±46.5)ml/min (P=0.001).脑出血供者的供肾移植前的活检显示均有不同程度的肾小球硬化(13.5％±6.9％).脑出血供者组和脑外伤供者组术后移植肾功能恢复延迟发生率分别为18.5％和10.5％,急性排斥反应发生率分别为14.8％和7.9％,差异均无统计学意义(P＞0.05).脑出血供者组术后1、6和12个月时估算的肾小球滤过率分别为(50.0±11.7)、(50.1±13.8)和(48.0±15.8) ml/min,均显著低于脑外伤供者组的(62.5±14.2)、(64.1±13.9)和(69.1±14.9)ml/min(P＜0.01).随访3～28个月,脑出血供者组和脑外伤供者组的移植肾存活率分别为92.6％(25/27)和100％(38/38),差异无统计学意义(P＞0.05).结论应有选择性地采用高血压脑出血致心死亡者的供肾移植,移植前应综合判断供肾质量,并行供肾组织活检,其肾脏宜优先移植给低体质量的老年受者.
목적 탐토고혈압뇌출혈치심사망자공신이식적효과.방법 회고분석14례고혈압뇌출혈치심사망자(고혈압뇌출혈공자)、19례뇌외상치심사망자(뇌외상공자)적공신자료,이급접수기공신이식적수자자료,공자부합중국이류혹삼류표준,차균위표준공자,기중접수고혈압뇌출혈자공신이식27례(뇌출혈공자조),접수뇌외상자공신이식38례(뇌외상공자조).고혈압뇌출혈자적공신균채용궤기관주보존,뇌외상자적공신유8례채용궤기관주보존.량조적면역억제방안상동.분석고혈압뇌출혈공자공신이식적효과,병여뇌외상공자공신이식상비교.결과 고혈압뇌출혈공자적최대기항청제솔위(86.6±19.5)ml/min,현저저우뇌외상공자적(129.6±46.5)ml/min (P=0.001).뇌출혈공자적공신이식전적활검현시균유불동정도적신소구경화(13.5％±6.9％).뇌출혈공자조화뇌외상공자조술후이식신공능회복연지발생솔분별위18.5％화10.5％,급성배척반응발생솔분별위14.8％화7.9％,차이균무통계학의의(P＞0.05).뇌출혈공자조술후1、6화12개월시고산적신소구려과솔분별위(50.0±11.7)、(50.1±13.8)화(48.0±15.8) ml/min,균현저저우뇌외상공자조적(62.5±14.2)、(64.1±13.9)화(69.1±14.9)ml/min(P＜0.01).수방3～28개월,뇌출혈공자조화뇌외상공자조적이식신존활솔분별위92.6％(25/27)화100％(38/38),차이무통계학의의(P＞0.05).결론응유선택성지채용고혈압뇌출혈치심사망자적공신이식,이식전응종합판단공신질량,병행공신조직활검,기신장의우선이식급저체질량적노년수자.
Objective To explore the effect of kidney transplantation from cardiac death standard criteria donors of hypertensive cerebral hemorrhage (HCH).Method The clinical data of donation after cardiac death (DCD) donors died from HCH (n =14) or brain trauma (n =19) and their renal transplant recipients were retrospectively analyzed.All donors fell into China Category Ⅱ or Ⅲ and were standard criteria donors.Twenty-seven recipients received kidney transplants from HCH donors (HCH group) and 38 recipients received kidney transplants from brain trauma donors (brain trauma group).All kidneys from HCH donors and 8 kidneys from brain trauma donors were preserved by machine perfusion.The immunosuppressive therapy protocol of two groups were similiar.The results of kidney transplantation from HCH donors were analyzed and compared to those from DCD donors died from brain trauma.Result The mean maximal calculated creatinine clearance rate of the HCH donors was significantly lower than that of the brain trauma donors (86.6 ± 19.5 vs.129.6 ±46.5 ml/min,P =0.001).All kidneys from HCH donors showed glomerulosclerosis to varying degrees (13.5％ ± 6.9％).After transplantation,the incidence of delayed graft function (18.5％ in HCH group vs.10.5％ in brain trauma group) and acute rejection (14.8％ in HCH group vs.7.9％ in brain trauma group) of two groups were similar (P＞0.05).The HCH group had significantly lower estimated glomerular filtration rate (eGFR) at 1st,6th and 12th month after transplantation (50.0± 11.7,50.1 ± 13.8 and 48.0± 15.8 ml·min 1 ·[1.73 m2]-1,respectively) than brain trauma group (62.5 ± 14.2,64.1 ± 13.9 and 69.1 ± 14.9 ml·min1 · [1.73 m2]-1,respectively).During a follow-up period of 3～28 months,the acturial graft survival rate of HCH group and brain trauma group was 92.6％ (25/27) and 100％ (38/38),respectively (P＞0.05).Conclusion The eGFR of renal grafts from HCH donors was significantly lower than that of the grafts from brain trauma donors,and the allografts from HCH donors showed accelerated deterioration in function in the first year after transplantation.The kidneys from HCH donors should be biopsied before implantation and allocated preferably to older recipients with lower body mass index.