传统尸体供肾与心脏死亡器官捐献供肾肾移植效果的比较

目的比较心脏死亡器官捐献（donation after cardiac death，DCD）供肾与传统尸体供肾肾移植的临床效果。方法回顾性分析2012年1月至2013年2月在郑州人民医院实施肾移植的70例患者的临床资料。根据供肾来源分为DCD供肾组（DCD组，22例）和传统尸体供肾组（传统组，48例）。患者均签署知情同意书，符合医学伦理学规定。比较两组患者术后7、14、28d肾功能指标血尿素氮（BUN）和血清肌酐（Scr）水平差异。比较两组患者术后1个月内并发症发生情况及预后情况。结果DCD组术后7、14d的BUN和Scr水平均明显高于传统组（均为P〈0．01）；DCD组术后28d的scr水平亦明显高于传统组（P〈0．05），两组BUN水平差异无统计学意义（P〉0．05）。与传统组比较，DCD组的移植物功能延迟恢复（DGF）、急性排斥反应（AR）、感染、移植肾切除的发生率及死亡率明显增高，差异有统计学意义（均为P〈0．01）。结论DCD供。肾肾移植术后早期肾功能恢复情况不如传统尸体供肾，且围手术期内各种并发症的发生率及死亡率也明显高于传统尸体供肾肾移植。

Comparison of the effect of renal transplantation between traditional cadaver donor and donation after cardiac death

Objective To compare the clinical effect of renal transplantation between traditional cadaver donor and donation after cardiac death （DCD）. Methods Clinical data of 70 patients who underwent renal transplantation in the People＇s Hospital of Zhengzhou from January 2012 to February 2013 were retrospectively analyzed. According to donor kidney source, 70 patients were divided into DCD donor group （DCD group, n = 22） and traditional eadaveric donor group （tradition group, n --48）. Local ethical committee approval had been received and the informed consent of all participating subjects was obtained. Levels of the patients＇ blood urea nitrogen （BUN） and serum creatinine （Scr） between two groups were compared at 7, 14, 28 d after transplantation. And the occurrence of complications and prognosis were also compared at 1 month after transplantation. Results The levels of BUN and Scr of DCD group at 7, 14 d after transplantation were significantly higher than those of traditional group （ all in P 〈0. 01 ）. And Scr level of DCD group at 28 d after transplantation was significantly higher than that of traditional group （ P 〈 0. 05 ） , but there was no significant difference in BUN level between the two groups （P 〉 0. 05 ）. Compared with traditional group, incidence rate of delayed graft function （DGF） , acute rejection, infection, transplant nephrectomy and mortality of DCD group was significantly higher, and the difference was significant （ all in P 〈 0. 01 ）. Conclusions The recovery of renal function of DCD donor is not as good as that of traditional eadaveric donor at the early stage after transplantation. And the incidences of complications and mortality are also significantly higher than those in traditional cadaveric donor renal transplantation.