CAJ | 학술논문

目的：探讨DCD捐献肾脏移植的经验及免疫诱导的临床效果观察。方法分析本院于2011年12月至2013年12月完成的40例DCD捐献肾移植患者的临床资料，根据免疫诱导药物的不同，分为舒莱组（10例）、ATG组（15例）和ATG－F组（15例）。结果40例患者中除3例出现DGF外，其余患者术后血肌酐均平稳下降，恢复正常；3组患者中均有1例发生DGF，ATG组发生急排1例，其余组无急排发生；所有组均无原发肾无功能发生；CMV发生率：舒莱组4例（40％），ATG组10例（71％），ATG－F组11例（73％）；ATG组发生肺部感染1例，其余组均无肺炎发生；ATG、ATG－F组分别有5、6例出现血小板及血红蛋白下降，无其他不良反应；除ATG组肺炎患者死亡外，其余均带功存活；术后恢复正常的肾脏病理表现为肾小球及肾小管结构清晰，而DGF的活检病理表现为肾小管肿胀，部分肾小管变性坏死。结论 DCD是解决我国器官移植界瓶颈的重要手段，中国三类（DBCD）是较理想的DCD供者。免疫诱导能够有效预防急性排斥的发生，但可引起机体广泛抑制，导致潜伏的CMV复活；取肾过程中尽量缩短热缺血时间，DGF发生率较低。供肾零点活检应该成为DCD供肾肾脏移植的常规检查项目，但慎重决定取舍。
목적：탐토DCD연헌신장이식적경험급면역유도적림상효과관찰。방법분석본원우2011년12월지2013년12월완성적40례DCD연헌신이식환자적림상자료，근거면역유도약물적불동，분위서래조（10례）、ATG조（15례）화ATG－F조（15례）。결과40례환자중제3례출현DGF외，기여환자술후혈기항균평은하강，회복정상；3조환자중균유1례발생DGF，ATG조발생급배1례，기여조무급배발생；소유조균무원발신무공능발생；CMV발생솔：서래조4례（40％），ATG조10례（71％），ATG－F조11례（73％）；ATG조발생폐부감염1례，기여조균무폐염발생；ATG、ATG－F조분별유5、6례출현혈소판급혈홍단백하강，무기타불량반응；제ATG조폐염환자사망외，기여균대공존활；술후회복정상적신장병리표현위신소구급신소관결구청석，이DGF적활검병리표현위신소관종창，부분신소관변성배사。결론 DCD시해결아국기관이식계병경적중요수단，중국삼류（DBCD）시교이상적DCD공자。면역유도능구유효예방급성배척적발생，단가인기궤체엄범억제，도치잠복적CMV복활；취신과정중진량축단열결혈시간，DGF발생솔교저。공신영점활검응해성위DCD공신신장이식적상규검사항목，단신중결정취사。
Objective To investigate the experience of renal transplantation of donation after cardiac death and clinical effect of immune-induced therapy. Methods We retrospectively analyzed 40 renal transplantation of donation after cardiac death in our hospital from Dec 2011 to Dec 2013 . According to the different immune-inducing drugs,the recipients were divided into three groups:basiliximab group(10 cases),ATG group (15 ca-ses)and ATG-F group (15 cases). Results Among 40 patients,the serum creatinines were steadily decreased in the postoperative period except 3 cases. One case of DGF appeared in each group. One case of acute rejection appeared in ATG group and the rest had no acute rejection occurred,the primary non-functioning kidney was not occurred in the three group. The incidence of CMV infections were 40%,71%and 73% respectively. Pneu-monia occurred 1 case in ATG group,the rest of the groups had no pneumonia. The decline of platelets and he-moglobin were observed in 5 and 6 cases in ATG group and ATG-F group,no other adverse effects were ob-served. Except one case of pneumonia died in ATG group,the rest were all alive with functional kidney. The clear structures of glomerular and tubular were observed in no-DGF kidney,while the swelling renal tubular and some necrosis tubular appeared in DGF kidney. Conclusions DCD is an important means to solve the short-age of organ. DBCD is an ideal DCD donor. Induced immunity can be effective in preventing the occurrence of acute rejection,but it can cause the widespread suppression,which can lead to the latent resurrection of CMV, the warm ischemia time should be as short as possible,which can cause a low incidence of DGF. Renal biopsy should be done for a routine examination in DCD,but the decision of choose should be carefully done.