中华器官移植杂志
中華器官移植雜誌
중화기관이식잡지
Chinese Journal of Organ Transplantation
2015年
6期
325-329
,共5页
昌盛%徐晶%蒋继贫%陈知水
昌盛%徐晶%蔣繼貧%陳知水
창성%서정%장계빈%진지수
供者%供者选择%肾移植%移植物存活%器官获取
供者%供者選擇%腎移植%移植物存活%器官穫取
공자%공자선택%신이식%이식물존활%기관획취
Donors%Donor selection%Kidney transplantation%Graft survival%Organ harvesting
目的 分析单中心公民逝世后器官捐献(DCD)供肾移植的短期临床效果.方法 对2010年11月至2014年12月31日实施的242例DCD供肾移植的临床资料进行回顾性研究,统计术后1年受者和移植肾存活率,计算术后各类并发症发生率,并观察婴幼儿或儿童以及老年(年龄＞60岁)供者供肾移植的临床特点.结果 共计183例DCD捐献者,供者年龄为2d至68岁,其中中国一类(国际标准化脑死亡器官捐献)供者102例,中国二类(国际标准化心死亡器官捐献)供者22例,中国三类(中国过渡时期脑-心双死亡标准器官捐献)供者59例.最终捐献247个肾脏用于移植,实施肾移植242例,其中单肾移植237例,双肾移植5例.受者年龄为(43.3±21.8)岁(12～64岁).术后1年受者总体存活率为93.8％(227/242),低于既往传统尸体肾移植95.4％的存活率,但差异无统计学意义(P＞0.05).术后1年移植肾总体存活率为90.5％(219/242),低于既往传统尸体肾移植94.3％的存活率(P＜0.05).术后DGF的发生率为33.1％(80/242),高于既往传统尸体肾移植23.6％的发生率(P＜0.05).而术后1年急性排斥反应发生率、间质性肺炎发生率以及尿瘘、输尿管梗阻、心脑血管意外等并发症发生率与既往传统尸体肾移植相比较,差异无统计学意义(P＞0.05).婴幼儿及儿童供肾移植总体结果良好,移植肾体积在术后3个月之内生长至接近成人肾脏大小.老年供肾弃用率高于总弃用率(P＜0.05),但总体移植效果良好.结论 对于DCD供肾移植,严格筛选供者、加强供者濒死期器官维护、综合评估器官质量是提高受者长期存活、降低术后并发症发生率的关键.未成年供者供肾移植是解决供肾短缺的一条可行途径,无论是双肾移植还是单肾移植,均可获得优良的远期效果.而年龄＞60岁供者供肾尽管弃用率较高,但只要肾脏质量评估得当,并不影响短期疗效.
目的 分析單中心公民逝世後器官捐獻(DCD)供腎移植的短期臨床效果.方法 對2010年11月至2014年12月31日實施的242例DCD供腎移植的臨床資料進行迴顧性研究,統計術後1年受者和移植腎存活率,計算術後各類併髮癥髮生率,併觀察嬰幼兒或兒童以及老年(年齡＞60歲)供者供腎移植的臨床特點.結果 共計183例DCD捐獻者,供者年齡為2d至68歲,其中中國一類(國際標準化腦死亡器官捐獻)供者102例,中國二類(國際標準化心死亡器官捐獻)供者22例,中國三類(中國過渡時期腦-心雙死亡標準器官捐獻)供者59例.最終捐獻247箇腎髒用于移植,實施腎移植242例,其中單腎移植237例,雙腎移植5例.受者年齡為(43.3±21.8)歲(12～64歲).術後1年受者總體存活率為93.8％(227/242),低于既往傳統尸體腎移植95.4％的存活率,但差異無統計學意義(P＞0.05).術後1年移植腎總體存活率為90.5％(219/242),低于既往傳統尸體腎移植94.3％的存活率(P＜0.05).術後DGF的髮生率為33.1％(80/242),高于既往傳統尸體腎移植23.6％的髮生率(P＜0.05).而術後1年急性排斥反應髮生率、間質性肺炎髮生率以及尿瘺、輸尿管梗阻、心腦血管意外等併髮癥髮生率與既往傳統尸體腎移植相比較,差異無統計學意義(P＞0.05).嬰幼兒及兒童供腎移植總體結果良好,移植腎體積在術後3箇月之內生長至接近成人腎髒大小.老年供腎棄用率高于總棄用率(P＜0.05),但總體移植效果良好.結論 對于DCD供腎移植,嚴格篩選供者、加彊供者瀕死期器官維護、綜閤評估器官質量是提高受者長期存活、降低術後併髮癥髮生率的關鍵.未成年供者供腎移植是解決供腎短缺的一條可行途徑,無論是雙腎移植還是單腎移植,均可穫得優良的遠期效果.而年齡＞60歲供者供腎儘管棄用率較高,但隻要腎髒質量評估得噹,併不影響短期療效.
목적 분석단중심공민서세후기관연헌(DCD)공신이식적단기림상효과.방법 대2010년11월지2014년12월31일실시적242례DCD공신이식적림상자료진행회고성연구,통계술후1년수자화이식신존활솔,계산술후각류병발증발생솔,병관찰영유인혹인동이급노년(년령＞60세)공자공신이식적림상특점.결과 공계183례DCD연헌자,공자년령위2d지68세,기중중국일류(국제표준화뇌사망기관연헌)공자102례,중국이류(국제표준화심사망기관연헌)공자22례,중국삼류(중국과도시기뇌-심쌍사망표준기관연헌)공자59례.최종연헌247개신장용우이식,실시신이식242례,기중단신이식237례,쌍신이식5례.수자년령위(43.3±21.8)세(12～64세).술후1년수자총체존활솔위93.8％(227/242),저우기왕전통시체신이식95.4％적존활솔,단차이무통계학의의(P＞0.05).술후1년이식신총체존활솔위90.5％(219/242),저우기왕전통시체신이식94.3％적존활솔(P＜0.05).술후DGF적발생솔위33.1％(80/242),고우기왕전통시체신이식23.6％적발생솔(P＜0.05).이술후1년급성배척반응발생솔、간질성폐염발생솔이급뇨루、수뇨관경조、심뇌혈관의외등병발증발생솔여기왕전통시체신이식상비교,차이무통계학의의(P＞0.05).영유인급인동공신이식총체결과량호,이식신체적재술후3개월지내생장지접근성인신장대소.노년공신기용솔고우총기용솔(P＜0.05),단총체이식효과량호.결론 대우DCD공신이식,엄격사선공자、가강공자빈사기기관유호、종합평고기관질량시제고수자장기존활、강저술후병발증발생솔적관건.미성년공자공신이식시해결공신단결적일조가행도경,무론시쌍신이식환시단신이식,균가획득우량적원기효과.이년령＞60세공자공신진관기용솔교고,단지요신장질량평고득당,병불영향단기료효.
Objective To analyze the outcomes of renal transplantation from donation after citizen death (DCD) in our single center.Method We retrospectively investigated the recipient outcomes of renal allografts from DCD.Between November 2010 and 31st December 2014,our institution performed 242 renal transplants from DCD.Outcome variables (survival of recipients/allografts and adverse events) and characteristics of marginal donor transplants were analyzed.Result There were 139 males and 44 females in the enrolled 183 donors,and the range of age was from 2 days to 68 years.183 donors included 102 cases of donation after brain death (category Ⅰ),22 cases of donation after circulatory death (category Ⅱ) and 59 cases of donation after brain death followed by circulatory death (category Ⅲ).Utilizing these renal allografts,we performed 242 kidney transplantations including 237 single kidney transplants and 5 pediatric en bloc kidney transplants.The age of recipients ranged from 12 to 64 years.The data indicated that the 1-year recipient/allograft survival rate was 93.8％ and 90.5％,respectively.The rate of delayed graft function (DGF) was 33.1 ％,higher than that from executed prisoners allografts (23.6％,P＜0.05).However,the rate of 1-year acute rejection,interstitial pneumonia and the other adverse events (urinary fistula,ureteral obstruction and cardiac and cerebral vascular accident,etc.) was similar to that from executed prisoners allografts.In addition,good results from pediatric and elder donor renal transplantation were shown in our data,even though the discard rate of elder donor kidney was high.Conclusion By comprehensive evaluation,strictly screening donors and enhancing the rnanagenent of donors,the long-term survival of recipients may be prolonged and the incidence of DGF and primary graft non-function (PNF) may be decreased.The marginal donors from pediatric and elder DCD donors could be utilized in clinical transplantation safely and effectively as long as reasonable evaluation was carried out.
