单中心扩展标准的公民逝世后器官捐献肾移植的近期效果观察

目的分析扩展标准的公民逝世后器官捐献(ECD)肾移植病人的近期效果。方法ECD肾移植50例,标准的公民逝世后器官捐献(SCD)肾移植140例,比较两组移植肾病人早期恢复情况、术后1年内移植肾功能变化、受者和移植肾存活情况以及排斥反应、感染和手术并发症发生率。结果 ECD肾移植组病人术后1年的受者和移植肾存活率、总体感染发生率、急性排斥反应发生率与同期SCD组病人比较,差异均无统计学意义(P0.05)。但ECD组病人在肾移植术后第1、3、6、12个月血肌酐水平高于SCD组,ECD组肾小球滤过率(eGFR)SCD组,差异有统计学意义(P0.05)。结论现行ECD纳入标准下ECD肾移植术后近期效果良好,虽然在移植肾功能(血肌酐水平和eGFR)方面差于SCD肾移植,但在合理选择受者的前提下ECD可作为扩大供体来源的重要途径,其远期效果仍需进步观察。     

儿童供肾双肾移植临床效果研究

目的探讨儿童逝世后器官捐献供肾双肾整块肾移植的临床效果。方法回顾性分析9例儿童供肾双肾移植供、受者临床资料。计算受者的1年人、肾存活率,观察术后1年受者肾功能恢复情况,移植肾长度变化及术后不良事件发生情况。结果 9例受者术后1年的人、肾存活率分别为8/9、72%。随访1年,血清肌酐(Scr)水平由术前(747±170)μmol/L下降至(83±27)μmol/L,血尿素氮由术前(24.5±4.9)mmol/L下降至(6.8±2.0)mmol/L,移植肾长度由术前(61.1±9.8)mm增长至(100.3±1.7)mm。术后发生移植物功能延迟恢复(DGF)2例,行血液透析过渡后恢复移植肾功能;发生急性排斥反应2例,予甲泼尼龙冲击治疗后逆转;1例于术后2周发生肺部真菌感染,停用免疫抑制剂,予抗真菌治疗,但效果不佳,于术后3个月死亡;1例术后7 d发生移植肾动脉血栓形成,术后10 d行移植肾切除术,恢复血液透析;1例术后1个月发生1个移植肾动脉栓塞,剩余移植肾功能正常,术后6个月生长明显。此外,发生移植肾输尿管狭窄2例、蛋白尿2例、腹主动脉狭窄1例、尿瘘1例,经相应处理后均治愈或好转。结论儿童逝世后器官捐献供肾双肾整块肾移植围手术期并发症较多,但随着经验逐步积累,儿童双供肾肾移植的移植效果在逐步改善。     

婴幼儿公民逝世后器官捐献成人双肾移植的临床效果(附2例报告)

目的探讨婴幼儿公民逝世后器官捐献成人肾移植的临床效果。方法回顾性分析2例婴幼儿供肾成人肾移植的临床资料、手术方式、免疫抑制剂应用和随访情况并复习相关文献。结果 1例男性受者原发病为慢性肾脏病变、肾衰竭,术后移植肾功能恢复良好,移植肾体积逐渐增大,末次随访时(术后10个月)血清肌酐为84μmol/L。另1例女性受者原发病为肾衰竭尿毒症期,术后23 d死于心力衰竭合并严重肺部感染。2例受者均未发生血管并发症。结论婴幼儿捐献成人肾移植术后早期临床效果良好,移植肾增长迅速。术中精细操作,有利于预防供肾动脉血栓栓塞等并发症的发生。     

机械灌注在公民逝世后器官捐献供肾质量维护方面的应用研究进展

公民逝世后器官捐献目前已成为我国器官捐献的主要来源,但是由于供者质量的复杂性,扩大标准供者(ECD)供肾占比增加,从而对供肾的可利用性以及肾移植受者术后的长期预后造成很大的影响.加强供肾质量的维护与评估,对于改善供肾质量、增加供肾获取与利用、改善受者和移植肾长期存活具有重要意义.机械灌注保存作为器官保存的重要方式之一,...     

儿童器官捐献供肾肾移植疗效的临床研究

目的探讨儿童器官捐献供肾移植的近期临床疗效。方法回顾性分析2013年11月至2015年12月西安交通大学第一附属医院肾移植科完成的15例儿童器官捐献供者,供给28例肾移植受者(其中双肾移植2例)的供、受者临床资料。结果 28例受者手术均获成功。移植肾热缺血时间中位数为12.5 min(0~17.0 min),冷缺血时间中位数为4.3 h(1.5~7.7 h)。术后出现移植物功能延迟恢复(DGF)4例、透析1例、因肺部感染死亡2例、肾吻合口狭窄和供肾血栓形成后切除移植肾各1例。术后随访1~24个月,受者存活26例(93%),带肾存活受者24例(86%),其移植肾功能均正常。结论儿童器官捐献供者双肾整块移植及单肾移植早期临床疗效较好。     

公民逝世后器官捐献供肾评估方法及改善的研究进展

公民逝世后器官捐献正逐渐成为我国器官移植的主要器官来源。公民逝世后器官捐献供肾受多种不稳定因素影响,其质量不能得到有效的保障,导致公民逝世后器官捐献移植肾术后原发性无功能和移植物功能延迟恢复的发生率较高。因此,提高术前评估水平、改善供肾质量、降低术后早期并发症发生率是公民逝世后器官捐献肾移植重点要解决的问题。本文针对目前公民逝世后器官捐献供肾的两种常用评估方法——术前供肾活组织检查和机械灌注,及改善供肾质量的方法——体外膜肺氧合(ECMO)进行述评,介绍其研究进展。     

体重<15kg儿童DCD单侧供肾用于成人肾移植的临床观察

目的评估体重15kg的儿童DCD(公民逝世后器官捐献,包括脑死亡捐献和心脏死亡捐献)供者单侧供肾用于成人肾移植的早期安全性及临床效果。方法回顾分析本院2013年2月至2015年2月间行体重15kg的儿童供肾成人肾移植18例(儿童供肾组),与同期成人供肾成人肾移植62例(成人供肾组)的临床资料,分析两组患者术后并发症;1个月、3个月、6个月及1年移植肾eGFR;术后6个月及1年人、移植肾存活率;儿童供肾组术后移植肾长径、eGFR的变化情况,蛋白尿、血尿发生情况。结果儿童供肾组DGF、AR、血管及泌尿系并发症发生率分别为22.22%、5.56%、5.56%和5.56%,成人供肾组为20.03%、3.26%、0%和0%(P均0.05);所有受者观察期间均未死亡,术后1个月儿童供肾组eGFR明显低于成人供肾组(P0.05),术后3个月、6个月及1年,两组eGFR无差异(P0.05)。儿童供肾组术后6个月及1年移植物存活率分别为93.80%和93.80%,而成人供肾组为98.20%和98.20%(P0.05);儿童供肾组移植肾eGFR、长径与术后时间呈正相关增长,观察期内儿童供肾组蛋白尿发生率与成人组相当,血尿发生率高于成人组。结论本组体重15kg的儿童DCD单侧供肾成人肾移植术后并发症、功能(依据eGFR评价)与成人组相当,供肾长径及移植肾eGFR在术后3~6个月可增至成人水平,低体重儿童单侧供肾成人肾移植手术并发症率低,近期效果满意,远期效果有待进一步观察。     

婴幼儿双供肾成人肾移植临床效果研究

目的探讨婴幼儿双供肾成人肾移植的临床疗效。方法回顾性分析2012年12月至2020年11月中山大学附属第一医院25例婴幼儿双供肾成人肾移植的供、受者临床资料。计算术后1、3、5年受者和移植肾存活率,观察受者术后肾功能恢复情况及术后不良事件发生情况。结果25例婴幼儿双供肾成人肾移植受者的第1、3、5年存活率均为95.8%,移植肾及死亡删失移植肾的第1、3、5年存活率均为87.2%。1例受者因急性下壁心肌梗死死亡,3例受者分别因移植肾血管血栓形成或输尿管狭窄、尿漏导致移植肾功能丧失。除受者移植肾功能丧失及死亡外,术后1、2、3年估算肾小球滤过率分别为:(99.35±21.78)ml/(min·1.73 m2)、(103.11±29.20)ml/(min·1.73 m2)、(114.99±28.55)ml/(min·1.73 m2)。结论婴幼儿器官捐献供肾的双肾成人肾移植的总体移植效果较满意,做好供、受者匹配,规范供肾获取及手术流程,加强围术期管理可提高成人受者长期疗效,可作为扩大供者来源的重要途径。     

公民逝世后器官捐献供肾肾移植术后肺部感染风险因素分析

目的探讨公民逝世后器官捐献供肾肾移植术后受者发生肺部感染的影响因素。方法回顾性分析中南大学湘雅三医院器官移植中心自2010年4月至2014年12月公民逝世后器官捐献供肾肾移植125例供者与210例受者的临床资料。根据移植术后有否发生肺部感染将受者分为肺部感染组(37例)和无肺部感染组(173例)。了解肺部感染受者的一般情况和预后。对供者因素(性别、年龄、维持治疗时间、感染史)、受者因素[性别、年龄、吸烟史、糖尿病史,术前血红蛋白、白细胞、中性粒细胞百分比、白蛋白、血清肌酐等水平,术后有否急性排斥反应、有否使用生物制剂、有否预防性应用更昔洛韦及复方磺胺甲唑(SMZ)]进行单因素分析和多因素Logistic回归分析,找出肺部感染的独立危险因素。结果与结论 37例肺部感染患者中,8例发展为重症肺部感染死亡。公民逝世后器官捐献供肾肾移植术后受者发生肺部感染的独立危险因素包括供体维持治疗时间、有感染史,受体吸烟史、糖尿病史、无预防性应用更昔洛韦或SMZ。     

传统开放手术联合经皮顺行通道内镜微创治疗移植肾输尿管梗阻一例

<正>输尿管梗阻是肾移植术后常见的泌尿系统并发症,病因复杂,若诊治不及时可能会导致移植肾功能丧失,严重影响肾移植受者术后生存质量。2018年3月,南方医科大学珠江医院器官移植科采用传统开放手术联合经皮顺行通道内镜微创手术成功治疗1例肾移植术后并发移植肾输尿管梗阻受者,现报道如下。1病例资料受者男性,50岁。2017年12月20日因"尿毒症"于我院接受公民逝世后器官捐献供肾肾移植手     

儿童心脏死亡器官捐献供者双肾整块移植早期临床疗效观察

目的：观察儿童心脏死亡器官捐献（ DCD ）供者双肾整块移植的早期临床疗效。方法回顾性分析中山大学附属第一医院器官移植中心2010年2月至2013年9月儿童DCD供者双肾整块移植供、受者临床资料。6例儿童DCD供者中位年龄3岁（10个月～6岁）,均捐献给相同血型受者。6例受者中位年龄39．5岁（17～48岁）,成年人5例,17岁男性1例,原发病均为慢性肾小球肾炎;均为首次肾移植,群体反应性抗体均阴性, HLA错配数1～4个。均采用右侧髂窝整块移植法。结果6例受者手术均获成功。移植肾热缺血时间中位数为17．5 min （0～23 min）,冷缺血时间中位数为6．6 h （4．8～7．4 h）。术后肾功能恢复均较顺利,未发生急性排斥反应、移植肾原发性无功能和移植肾功能延迟。其中4例为移植肾功能立即恢复（即术后第5天血清肌酐≤265μmol/L ）,2例为移植肾功能缓慢恢复（即术后第5天血清肌酐＞265μmol/L）。1例受者术后7 d右侧移植肾动脉血栓形成;1例受者术后15 d诊断为肺结核行正规抗结核治疗;1例受者术后1年出现移植肾动脉吻合口狭窄,介入治疗后恢复。术后随访1～36个月,受者和移植肾全部存活,所有受者肾功能均正常。结论儿童DCD供者双肾整块移植早期临床疗效良好,是一种扩大供者来源的良好途径。     

Clinical analysis on 48 cases of kidney transplantation from brain and cardiac death donors

Objective To observe the short-term clinical outcomes of kidney transplantation from brain and cardiac death donors (DBCD) and assess its feasibility to expand organ donor pool. Methods A retrospective analysis was performed on 48 cases of kidney transplantation from DBCD.The transplant recipients had finished 12-month follow-up in the First People's Hospital of Foshan from September 2011 to February 2015, with their renal function, rejection reaction and complications at 1 week, 1 month, 3 months, 6 months and 12 months after renal transplantation being collected. Survival rates of transplant recipients and transplant kidneys, incidence of delayed graft function (DGF) and its influence for recipients and graft survival were analyzed by statistics. Results In the 48 cases, the survival rates of recipients at 1, 3, 6 and 12 months after transplantation were 100.0%, 100.0%, 97.9%, 95.8%, and the survival rates of transplanted kidneys were 95.8%, 95.8%, 93.8%, 91.7%, respectively. DGF occurred in 8 of 48 (17.0%), but the occurrence of DGF did not adversely influence patient's survival (P=0.524) or graft survival (P=0.362). Conclusions The short-term clinical outcomes of kidney transplantation from DBCD are ideal. As the legislation of donation after brain death (DBD) has not been ratified in China, the kidney transplantation from DBCD could be an important way to solve the shortage of organs, and increase the number of kidneys available for transplantation.     

公民身后器官捐献肝移植术后早期细菌和真菌感染并发症的临床特点与危险因素分析

目的对比分析公民身后器官捐献与传统司法途径器官捐献肝移植术后早期受体细菌和真菌感染并发症的临床特点,探讨公民身后器官捐献肝移植受体术后感染的危险因素。 方法回顾性研究2011年1月至2013年12月间本中心实施的公民身后器官捐献肝脏供、受体（研究组）和司法途径来源器官捐献的肝移植受体病例（对照组）,比较两组受体术后细菌、真菌感染的临床特点和预后,分析术后受体感染的危险因素。 结果共纳入公民身后器官捐献肝脏供体43例;研究组受体72例,对照组受体80例。研究组受体的细菌、真菌感染总发生率显著高于对照组（47.2% vs 31.2%）（χ²=4.071,P=0.044）。研究组受体术后1周内的细菌感染率高于对照组（64.5% vs 38.2%）（χ²=6.133,P=0.018）。供体捐献前感染和开放性创伤史是术后受体感染的独立危险因素（P=0.025、0.031）。4例疑似供体来源性受体感染,占研究组总感染例数的11.8%（4/34）。 结论使用公民身后器官捐献来源器官的肝移植术后受体感染发生率显著高于传统司法途径来源,发生细菌感染的时间更早。供体器官捐献前存在感染和有开放性创伤是肝移植术后受体发生感染的危险因素。     

Successful DCD Kidney Transplantation Using Early Corticosteroid Withdrawal

Organs from donors after cardiac death (DCD) are being increasingly utilized. Prior reports of DCD kidney transplantation involve the use of prednisone-based immunosuppression. We report our experience with early corticosteroid withdrawal (ECSW). Data on 63 DCD kidney transplants performed between 2002 and 2007 were analyzed. We compared outcomes in 28 recipients maintained on long-term corticosteroids (LTCSs) with 35 recipients that underwent ECSW. DGF occurred in 49% of patients on ECSW and 46% on LTCS (p = 0.8). There was no difference between groups for serum creatinine or estimated GFR between 1 and 36 months posttransplant. Acute rejection rates at 1 year were 11.4% and 21.4% for the ECSW and LTCS group (p = 0.2). Graft survival at 1 and 3 years was 94% and 91% for the ECSW group versus 82% and 78% for the LTCS group (p ≥ 0.1). Death censored graft survival was significantly better at last follow-up for the ECSW group (p = 0.02). Multivariate analysis revealed no correlation between the use of corticosteroids and survival outcomes. In conclusion, ECSW can be used successfully in DCD kidney transplantation with no worse outcomes in DGF, rejection, graft loss or the combined outcome of death and graft loss compared to patients receiving LTCS.     

扩大标准公民逝世后器官捐献肾移植术后一年内临床效果分析

目的观察并比较扩大标准供者(ECD)和标准供者(SCD)供肾移植受者术后1年内临床效果。 方法回顾性分析2014年3月至2017年3月空军军医大学西京医院接受公民逝世后器官捐献90例肾移植受者临床资料,按供肾来源分为ECD组(31例)和SCD组(59例)。所有受者均应用免疫诱导及三联免疫抑制方案治疗(吗替麦考酚酯或麦考酚钠肠溶片＋他克莫司或环孢素＋甲泼尼龙)。采用t检验或Mann-Whitney U检验比较两组受者肾移植术后1年内血清肌酐(Scr)水平,采用χ²检验和Fisher确切概率法比较两组受者性别比例、受者/移植肾存活率及急性排斥反应(AR)、移植肾功能延迟恢复(DGF)和肺部感染等并发症发生率。P<0.05为差异有统计学意义。 结果ECD组和SCD组肾移植受者术后Scr水平逐步下降。术后1个月内(术后1、3、7、14和21 d)两组受者Scr水平差异均无统计学意义(t＝0.076、0.905、0.670、0.893和0.048,P均>0.05);术后1～12个月,除术后9个月两组受者Scr水平差异无统计学意义(t＝1.727,P>0.05),其余各时间点ECD组受者Scr水平均高于SCD组,差异均有统计学意义(P均<0.05)。两组受者术后1年受者/移植肾存活率分别为93.1%/80.6%和91.5/84.7%,差异均无统计学意义(P＝0.734; χ²＝0.246,P>0.05)。ECD组和SCD组AR发生率分别为12.9%(4/31)和18.6%(11/59),DGF发生率分别为22.6%(7/31)和22.0%(13/59),肺部感染发生率分别为25.8%(8/31)和11.9%(7/59),其他并发症发生率分别为41.9%(13/31)和28.8%(17/59),差异均无统计学意义(P均>0.05)。 结论与SCD相比,ECD供肾移植仍可获得相当的临床效果。在目前供器官来源严重缺乏的情况下,ECD的合理选择可以扩大供肾来源。     

Kidney Transplantation From Donors After Cardiac Death: An Initial Report of 71 Cases From China

Shortage of deceased donors is a severe problem in recent years in China especially in a culture in which brain death criteria is not widely accepted. Donation after cardiac death (DCD) has been reported to expand the donor pool despite higher rates of primary nonfunction (PNF) and delayed graft function (DGF) after transplantation. We collected 71 DCD kidney transplants performed at our hospital between February, 2007 and June, 2012 with aims to demonstrate the feasibility of DCD donation in China. All patients were followed up, and postoperative complications and graft loss were recorded. The PNF rate was 2.8%, and DGF rate was 28.2%. The 1‐ and 3‐year graft survival was 95.7% and 92.4%. In conclusion, graft survival of DCD kidney transplantation in China is excellent despite of higher rates of PNF and DGF after transplantation.     

Acute kidney injury in donors of donation after brain plus cardiac death does not affect recipients' short-term prognosis in transplantation

Objective To investigate the clinical efficacy of renal transplantation from donors of donation after brain and cardiac death(DBCD) complicated with acute kidney injury (AKI), and summarize the clinical experience of evaluation and application. Methods The clinical data of the 45 DBCD donors and 80 recipients in the First People's Hospital of Foshan from September 2011 to September 2015 were retrospectively analyzed. DBCD donors were classified into the AKI group (n=26)and non-AKI group (n=19) according to the serum creatinine level and urine output when the donors were admitted to the intensive care unit (ICU) in this hospital. A total of 80 recipients were divided into the AKI group (n=46) and non-AKI group (n=34) correspondingly. The condition of the donors before organ procurement between the two groups was compared, and the incidence of various complications, the 1 years survival rates of recipients and graft after renal transplantation were compared between the two groups. Results Among 45 donors, 26 cases(57.8%) suffered from AKI. The serum creatinine of donors was significantly higher in the AKI group than that in the non-AKI group (P＜0.01). The incidence of delayed graft function (DGF) in AKI group and non-AKI group was 21.7% and 8.8% respectively (P＞0.05). After 1 years, the serum creatinine of the recipients in AKI group was significantly higher than that in non-AKI group [(134.9±63.4) μmol/L vs (106.6±28.2) μmol/L, P＜0.05], but the survival rates of recipients and grafts did no differ between the two groups (both P＞0.05). Conclusions The donors combined with AKI do not have a worse effect on the incidence of DGF, the 1-year survival rates of recipients and grafts after transplantation. So, the donors with AKI for transplantation can widen the origin of kidney grafts.     

The duration of asystolic ischemia determines the risk of graft failure after circulatory‐dead donor kidney transplantation: A Eurotransplant cohort study

Circulatory death donor (DCD) kidney transplantations are steadily increasing. Consensus reports recommend limiting donor warm ischemia time (DWIT) in DCD donation, although an independent effect on graft outcome has not been demonstrated. We investigated death‐censored graft survival in 18 065 recipients of deceased‐donor kidney transplants in the Eurotransplant region: 1059 DCD and 17 006 brain‐dead donor (DBD) kidney recipients. DWIT was defined as time from circulatory arrest until cold flush. DCD donation was an independent risk factor for graft failure (adjusted hazard ratio [HR] 1.28, 95% CI 1.10‐1.46), due to an increased risk of primary nonfunction (62/1059 vs 560/17 006; P < .0001). With DWIT in the model, DCD donation was no longer a risk factor, demonstrating that DWIT explains the inferior graft survival of DCD kidneys. Indeed, DCD transplants with short DWIT have graft survival comparable to that of standard‐criteria DBD transplants (P = .59). DWIT also associated with graft failure in DCDs (adjusted HR 1.20 per 10‐minute increase, 95% CI 1.03‐1.42). At 5 years after transplantation, graft failure occurred in 14 of 133 recipients (10.5%) with DWIT <10 minutes, 139 of 555 recipients (25.0%) with DWIT between 10 and 19 minutes, and 117 of 371 recipients (31.5%) with DWIT ≥20 minutes. These findings support the expert opinion–based guidelines to limit DWIT.     

The Impact of Anastomosis Time During Kidney Transplantation on Graft Loss: A Eurotransplant Cohort Study

Recent studies raised the concern that warm ischemia during completion of vascular anastomoses in kidney implantation harms the transplant, but its precise impact on outcome and its interaction with other risk factors remain to be established. We investigated the relationship between anastomosis time and graft survival at 5 years after transplantation in 13 964 recipients of deceased donor solitary kidney transplants in the Eurotransplant region. Anastomosis time was independently associated with graft loss after adjusting for other risk factors (adjusted hazard ratio [HR] 1.10 for every 10‐min increase, 95% confidence interval [CI] 1.06–1.14; p < 0.0001), whereas it did not influence recipient survival (HR 1.00, 95% CI 0.97–1.02). Kidneys from donation after circulatory death (DCD) were less tolerant of prolonged anastomosis time than kidneys from donation after brain death (p = 0.02 for interaction). The additive effect of anastomosis time with donor warm ischemia time (WIT) explains this observation because DCD status was no longer associated with graft survival when adjusted for this summed WIT, and there was no interaction between DCD status and summed WIT. Time to create the vascular anastomoses in kidney transplantation is associated with inferior transplant outcome, especially in recipients of DCD kidneys.     

Duration of Donor Brain Death and its Influence on Kidney Graft Function

Short- and long-term rates of success after cadaveric kidney transplantation are significantly inferior to those from living related or unrelated donors. The major difference between cadaveric and living donation is brain death. In the present study we analyzed the influence of duration of brain death on short- and long-term graft function after cadaveric kidney transplantation. The interval between declaration of donor brain death and the beginning of the cold ischemia time before graft explantation was defined as duration of brain death (DBD). The influence of DBD on incidence of primary graft function and on duration of delayed kidney graft function as well as on kidney graft survival was analyzed in 1106 patients transplanted in one center and confirmed in a validation study of a second series of 752 kidney graft recipients from another transplant center. Kidney grafts harvested from donors with longer DBD (>470 min) exhibited a significantly higher incidence of primary graft function and a significantly better graft survival rate in comparison to kidneys from donors with a shorter DBD (<470 min). The tendency of these results could be confirmed in an independent validation study; however, the differences were not statistically significant. Although the dramatic hemodynamic and immunological changes in brain-dead donors may impair the quality of a potential kidney transplant, a longer duration of donor brain death did not deteriorate early and long-term kidney graft function.