肾移植术后肾功能延迟恢复的原因和处理

背景、目的和方法我院自1978年4月至1998年1月共作1240例次尸体肾移植术，其中术后发生移植肾功能延迟恢复（DGF）的93例（7．5％）。为了探讨肾移植术后肾功能延迟恢复的原因，减少并发症，提高存活率，我们对供肾的摘取、灌洗、术中血压问题及术后免疫抑制剂的应用进行研究。结果93例中急性肾小管坏死（ATN）71例（76％），其中热缺血时间＞10min56例（60．2％）、冷缺血时间＞24h2例（2．2％）、术中收缩血压低于13kPa（98mmHg）13例（14％）。肾动脉痉挛致血管栓塞3例（3．2％），术后CsA中毒8例（8．6％），急性排斥（AR）11例（11．8％）。81例（87．1％）在7～66d内肾功能恢复正常，8例（8．6％）摘除移植肾，4例（4．3％）死亡。结论肾移植术后肾功能延迟恢复是造成肾移植失败的原因之一。缩短热缺血时间、注意移植肾灌洗量、严格控制术中血压变化、合理的应用CsA药物是减少肾移植术后并发症和提高成功率的关键。

Causes and treatment for delayed graft function after renal transplantation

Background,Objective and Metkod Between April 1978 and January 1998, 1 240 patients underwent renal transplantation in our department, of whom 93(7. 5%) patients suffered delayed graft function (DGF). To explore the causes of DGF after renal transplantation for decreasing the complication and increasing the survival rate, we studied the renal extraction and lavation, the blood pressure during operation and the usage of immunosupprersants. Results The causes of DGF in these patients acute tubular necrosis (ATN) in 71 (76% ) patients, which resulted from warm ischemic time> 10 min in 56 (60. 2% ), cold ischemic time>24 h in 2(2. 2% ), or the systolic pressure below 13 kPa (98 mmHg) during the operation in 13 (14 % ). vascu1ar embolism in 3 (3. 2 % ) patients due to renal arterial spasm, CsA toxicity in 8 (8. 6 % ) and acute rejection in 11. Eighty-one patients recovered well at 7 and 66 days after operation, 8 accepted nephrectomy, and 4 died. Conclusion DGF is an important factor for failure of renal transplantation. We think tht to shorten the warm ischemic time, pay more attention to the lavage volume, maintain stability of the blood pressure during the operation and rationally use CsA are the key to decreasing the complication and increasing the survival rate after renal transplantation