CAJ | 학술논문

目的探讨肾脏灌注运输器(LifePort)在公民逝世后供者器官捐赠(DCD)供肾移植中应用的临床效果.方法 2011年8月至2014年6月在吉林大学第一医院实施的146例DCD供肾移植,其中104例供肾应用LifePort进行低温持续灌注保存(LP组),另42例采用常规低温静态冷藏保存(对照组),对比分析两种保存方法对肾移植的早期影响.结果 146例肾移植均获得成功,围手术期(术后2周内)发生急性排斥反应17例,发生率为11.6％(17/146),经治疗后均逆转,其中LP组发生12例(11.5％,12/104),对照组发生5例(11.9％,5/42),发生率的差异无统计学意义(P＞0.05).发生移植肾功能恢复延迟(DGF)17例,发生率为11.6％(17/146),其中LP组发生DGF 8例(7.7％,8/104),对照组发生DGF 9例(21.4％,9/42),LP组DGF发生率低于对照组(P＜0.05).17例发生DGF者的移植肾功能在术后8～42 d恢复正常.未发生DGF的病例中,LP组术后第7天的平均血肌酐为(118.8±42.1)μmol/L,对照组为(183.6±57.1)μmol/L,差异有统计学意义(P＜0.05).LP组血肌酐恢复正常的时间为移植后(4.6±1.6)d,对照组血肌酐恢复正常的时间为移植后(8.3±2.3)d,差异有统计学意义(P＜0.05).随访中位时间为9个月,144例的随访时间≥6个月,随访第1个月的受者和移植肾存活率分别为100％(144/144)和100％(144/144),随访第6个月的受者和移植肾存活率分别为99.3％(143/144)和98.6％(142/144).结论应用LifePort对DCD供肾进行灌注保存是安全有效的,有利于降低DGF的发生率,缩短移植肾功能恢复时间.
목적 탐토신장관주운수기(LifePort)재공민서세후공자기관연증(DCD)공신이식중응용적림상효과.방법 2011년8월지2014년6월재길림대학제일의원실시적146례DCD공신이식,기중104례공신응용LifePort진행저온지속관주보존(LP조),령42례채용상규저온정태랭장보존(대조조),대비분석량충보존방법대신이식적조기영향.결과 146례신이식균획득성공,위수술기(술후2주내)발생급성배척반응17례,발생솔위11.6％(17/146),경치료후균역전,기중LP조발생12례(11.5％,12/104),대조조발생5례(11.9％,5/42),발생솔적차이무통계학의의(P＞0.05).발생이식신공능회복연지(DGF)17례,발생솔위11.6％(17/146),기중LP조발생DGF 8례(7.7％,8/104),대조조발생DGF 9례(21.4％,9/42),LP조DGF발생솔저우대조조(P＜0.05).17례발생DGF자적이식신공능재술후8～42 d회복정상.미발생DGF적병례중,LP조술후제7천적평균혈기항위(118.8±42.1)μmol/L,대조조위(183.6±57.1)μmol/L,차이유통계학의의(P＜0.05).LP조혈기항회복정상적시간위이식후(4.6±1.6)d,대조조혈기항회복정상적시간위이식후(8.3±2.3)d,차이유통계학의의(P＜0.05).수방중위시간위9개월,144례적수방시간≥6개월,수방제1개월적수자화이식신존활솔분별위100％(144/144)화100％(144/144),수방제6개월적수자화이식신존활솔분별위99.3％(143/144)화98.6％(142/144).결론 응용LifePort대DCD공신진행관주보존시안전유효적,유리우강저DGF적발생솔,축단이식신공능회복시간.
Objective To investigate the clinical effect of LifePort kidney transporter machines (LifePort) used in renal transplantation from donors after cardiac death (DCD).Method From Aug.2011 to June 2014,146 cases of kidney transplantation from DCD were performed in our department.104 cases were perfused by LifePort,as LP group,and the remaining 42 cases were preserved by static cold storage,as control group.Clinical data were analyzed retrospectively.Result All 146 cases of kidney transplantation from DCD were performed successfully.Seventeen cases (17/146,11.6％) showed acute rejection (AR) during perioperative period (2 weeks after transplantation),12 cases (11.5％,12/104) of acute rejection (AR) occurred in LP group,and 5 cases (11.9％,5/42) of AR occurred in control group (P＞0.05).All of AR recovered well after anti-AR treatment.There were 17 cases (11.6％,17/146) of delayed graft function (DGF) totally.The rate of DGF in LP group (7.7％,8/104) was significantly lower than in control group (21.4％,9/42) (P＜0.05).The serum screatinine (Scr) in patients with DGF recovered well between 8-42 days after transplantation after anti DGF-treatment.The mean value of Scr in the patients without DGF in LP group was significantly lower than in the control group (118.8 ± 42.1 vs.183.6 ± 57.1 μumol/L,P＜0.05).The recovery time of renal function in LP group was significantly shorter than in control group (4.6 ± 1.6 days vs.8.3 ± 2.3 days,P＜0.05).The median follow-up period was 9 months (144 patients were followed up over 6 months).The 1-,6-month survival rate of patient and renal graft was 100％/100％,99.3％/98.6％ respectively.Conclusion Perfusion and preservation of kidney from DCD using LifePort kidney transporter machines have perfect clinical effects and more advantages,including reducing the risk of DGF,and promoting the early recovery of renal allografts function.