亲属活体肾移植(附162例报告)

目的探讨亲属活体肾移植的疗效。方法亲属活体肾移植162例,除7例为夫妻间供肾外,其余为血缘亲属供肾。人类白细胞抗原(human leukocyte antigen,HLA)抗原错配5个4例、抗原错配4个6例、抗原错配3个101例、抗原错配2个51例。全部供者经开放手术取肾。受者术后采用环孢素或他克莫司+麦考酚吗乙酯+泼尼松龙三联免疫抑制治疗方案预防排斥反应。结果供者中除2名出现一过性血清肌酐升高外,其余肾功能均在正常范围内。162例受者中,术后早期肾功能恢复正常157例,肾功能延迟恢复5例,急性排斥反应5例,输尿管血栓形成2例,慢性排斥反应3例。1、3、5年人存活率均为96.9%,1、3、5年肾存活率分别为96.3%、95.8%、95.0%。死亡5例,死亡时间为移植后3个月内,均死于重度肺部感染并呼吸衰竭。结论亲属活体肾移植的组织配型好,供者术前准备充分,供肾缺血时间短,受者术前有充足的免疫诱导时间,免疫抑制剂用量小,排斥反应发生率低,移植肾存活率高。

Living-related donor renal transplantation: a report of 162 cases

Objective To study therapeutic effect of living-related donor renal transplantation.Methods One hundred and sixty-two patients underwent living-related donor renal transplantation in our center.Except seven cases receiving the transplants from their spouses,the remained cases received grafts from blood relatives.Donor-recipient human leukocyte antigen（HLA）matching showed 4 cases with 5-loci mismatch,6 cases with 4-loci mismatch,101 cases with 3-loci mismatch and 51 cases with 2-loci mismatch.All patients underwent nephrectomy by laparotomy.All recipients were given triple-combined immunosuppressive including cyclosporin（or tacrolimus）,mycophenolate mofetil and prednisolone.Results The renal function remained normal in most donors without impairment of life quality,except two donors with transient increasing of serum creatinine.Most recipients（157 out of 162）recovered normal renal function in early stage after transplantation.Five cases developed delayed graft function（DGF）,5 cases with acute rejection and 3 cases with chronic rejection（CR）.Another 2 cases developed thrombus in ureter and their renal function recovered after thrombus removal by operation.The 1-year,3-year,5-year survival rates of patients were 96.9 %,96.9 % and 96.9 %.The 1-year,3-year,5-year survival rates of grafts were 96.3 %,95.8 % and 95.0 %.Five patients died of serious wound infection and respiratory failure within 3 months.Conclusion Optimal HLA matches,sufficient preoperative preparation and less ischemia time may reduce the incidence of DGF and acute rejection in living-related donor renal transplantation.Sufficient immune induction pre-operation may reduce the dosage of immunosuppressant and the incidence of rejection.The renal grafts from living related donors has longer survival time compared with deceased donor renal transplantation.