亲属活体供肾移植后近期及中长期供者和受者的安全性分析

目的 探讨亲属活体供肾移植术后近期及中长期供、受者的安全性.方法 对106名亲属活体供肾者及其受者进行随访.随访日分别为肾移植后2个月至7年,其中32名供者随访时处于术后3个月内,44名处于术后3个月至1年,30名处于术后1年以上(其中术后1～3年者14名,3～5年者11名,5年以上者5名).以GFR作为评估供、受者肾功能的主要指标,比较供、受者手术前后的肾功能以及血压和尿蛋白.GFR的计算采用同位素发射计算机辅助断层显像法(GFR-ECT法)、24 h尿肌酐(Cr)清除率法(GFR-24 h Urine法)及Cockcroft-Gault公式法(GFR-Cr法).结果 取肾前106名供者的GFR-ECT和GFR-Cr分别为(1.51±0.13)和(1.99±0.42)ml/s,GFR-ECT是GFR-Cr的75.8%;术后第5天,供者的GFR-Cr为(1.40±0.33)ml/s,为术前的70.5%;术后3个月内、3个月至1年和1年以上者的GFR-Cr分别为(1.47±0.28)、(1.36±0.24)和(1.37±0.23)ml/s,分别为取肾术前的73.7%、68.0%和68.6%;术后1～3年者、3～5年者及5年以上者的GFR-Cr与超过1年者整体的GFR-Cr比较,差异无统计学意义(P>0.05).4名供者术后尿蛋白为±,均为术后超过1年者;4名供者血压升高.术后3个月、1年及1年以上,受者的GFR-Cr分别为(1.09±0.26)、(1.20±0.31)和(1.07±0.29)ml/s.结论 术后近期供者的GFR会下降,并小幅波动,术后中长期其GFR接近术前70%的水平,并趋于稳定.亲属活体供肾移植术后供、受者具有良好的安全性.

The safety of the donor and recipient in the short term and median-long term follow-up after living-related kidney transplantation

Objective To investigate the safety of Chinese donor and recipient in the short term and median-long term after living-related kidney transplantation.Methods 106 pairs of donors and recipients subject to living-related kidney transplantation were randomly selected.They were followed up from 2 months to 7 years after transplantation.Thirty-two pairs were in the duration of 3 months post-transplantation,44 pairs from 3 months to 1 year,and 30 pairs beyond 1 year(14 pairs from 1-3 years,11 pairs from 3-5 years,and 5 pairs beyond 5 years).GFR was used to evaluate kidney function.The kidney function,blood pressure and proteinuria were compared before and post transplantation in the donors and recipients.Results Before donation in 106 donors,GFR-ECT was 1.51±0.13,75.8% of GFR-Cr as 1.99±0.42 ml/s;5 days after operation,GFR-Cr in donors was 1.40±0.33 ml/s,a decreased level to 70.5%;GFR-Cr was 1.47±0.28,1.36±0.24 and 1.37±0.23 ml/s at 3rd month,3rd month-first year,and beyond 1 year,a decreased level to 73.7%,68.0%and 68.6%,respectively.No significant difference in GFR-Cr was found among the donors 1-3 years,3-5 years and beyond 5 years after operation as compared with the whole level in the donors beyond 1 year(P>0.05).Four donors,all beyond 1 year,were found having proteinuria trace,and 4 donors had a mild increase in blood pressure.The GFR-Cr in recipients was 1.09±0.26,1.20±0.31,and 1.07±0.29 ml/s at the 3rd month,first year,beyond 1 year after operation,respectively.Conclusion.The GFR in donors is decreased mildly and fluctuated in the short term after donation,then stabilize at a level of 70%.The donors and recipients have a good safety in the living-relatedkidney transplantation.