公民逝世后器官捐献肾移植546例的预后
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摘要
目的:探讨公民逝世器官捐献(DCD)肾移植受者的临床预后。方法:回顾性分析2013年6月～2018年7月中国人民解放军总医院第三医院中心肾移植科完成的546例公民逝世器官捐献肾移植供、受者临床资料。供者516例,男性399例、女性117例,年龄42.4±16.1岁(5～68岁);死亡原因以脑卒中和脑外伤为主。5～12岁儿童供肾20例,均做单肾给儿童或低体重成人,60岁以上老年供肾56例。546例受者中,男393例、女153例,平均年龄41.7±11.9岁。分析供肾质量、免疫诱导方案、术后移植肾功能、并发症、人肾生存率,以及特殊供肾和特殊受者的人肾存活情况。结果:本组受者术后无一例原发性移植肾无功能,移植肾功能延迟(DGF)36例(6.6%),急性排斥反应28例(5.1%)。术后42例(7.7%)并发肺部感染,死亡10例。移植肾功能丢失18例。儿童和老年供肾的受者预后较好;14例合并横纹肌溶解综合征相关性急性肾损伤的供肾,DGF发生率较高(42.9%);22例神经系统肿瘤供肾受者随访期间未发生肿瘤。本组受者人、肾存活率为97.2%和93.9%,1年、3年、5年的人、肾生存率分别为98.5%、96.9%、89.3%和96.5%、 92.7%、 85.6%。结论:本组DCD供肾受者人和肾脏预后较好,主要死亡原因是肺部感染;特殊供肾和特殊受者的预后值得关注。
Objective:To explore the prognosis of organ donation after citizen death(DCD) in kidney transplantation. Methodology:The data of 546 cases of DCD kidney transplantations performed in Third Medical Center, General Hospital of the Chinese People's Liberation Army between June 2013 and July 2018 was retrospectively reviewed. The 516 donors were aged from 5 to 68(42.4±16.1) years,including 399 males and 117 females; the main causes of death were cerebral apoplexy and brain trauma. Single kidney from 20 children were given to children or low-weight adult recipients. Of the 546 recipients, 393 were males and 153 were females, with an average age of 11 to 70(41.7±11.9) years. The quality of donor kidney, immune induction protocol, grafts function, complications, survival rate of recipient/kidney, and survival rate of special donor and special recipient were analyzed. Results:None of primary graft nonfunction occurred.Delayed graft function(DGF) occurred in 36 cases(6.6%) and acute rejection occurred in 28 cases(5.1%). 42 patients(7.7%) were suffed from pulmonary infection and 10 cases died. 18 patients lost their kidney function. The prognosis of recipients from children and the elderly donors were satisfactory; The incidence of DGF(42.9%) was higher in recipents from 14 acute renal injury donors related with rhabdomyolysis syndrome. There was no tumors recurrence in 22 recipients from nervous system tumors. The overall survival rate of person and kidney was 97.2% and 93.9%. The 1,3 and 5-year survival rate of person and kidney were 98.5%, 96.9%,89.3% and 96.5%, 92.7% and 85.6% respectively. Conclusion:The prognosis of DCD recipients and grafts were satisfactory. The main cause of death were pulmonary infection. Prognosis of specific kidney donors and recipients deserves attention.
Objective:To explore the prognosis of organ donation after citizen death(DCD) in kidney transplantation. Methodology:The data of 546 cases of DCD kidney transplantations performed in Third Medical Center, General Hospital of the Chinese People's Liberation Army between June 2013 and July 2018 was retrospectively reviewed. The 516 donors were aged from 5 to 68(42.4±16.1) years,including 399 males and 117 females; the main causes of death were cerebral apoplexy and brain trauma. Single kidney from 20 children were given to children or low-weight adult recipients. Of the 546 recipients, 393 were males and 153 were females, with an average age of 11 to 70(41.7±11.9) years. The quality of donor kidney, immune induction protocol, grafts function, complications, survival rate of recipient/kidney, and survival rate of special donor and special recipient were analyzed. Results:None of primary graft nonfunction occurred.Delayed graft function(DGF) occurred in 36 cases(6.6%) and acute rejection occurred in 28 cases(5.1%). 42 patients(7.7%) were suffed from pulmonary infection and 10 cases died. 18 patients lost their kidney function. The prognosis of recipients from children and the elderly donors were satisfactory; The incidence of DGF(42.9%) was higher in recipents from 14 acute renal injury donors related with rhabdomyolysis syndrome. There was no tumors recurrence in 22 recipients from nervous system tumors. The overall survival rate of person and kidney was 97.2% and 93.9%. The 1,3 and 5-year survival rate of person and kidney were 98.5%, 96.9%,89.3% and 96.5%, 92.7% and 85.6% respectively. Conclusion:The prognosis of DCD recipients and grafts were satisfactory. The main cause of death were pulmonary infection. Prognosis of specific kidney donors and recipients deserves attention.
引文
1 石炳毅.中国公民逝世器官捐献肾移植的发展与进步.中华器官移植杂志,2014,35(10):577-579.
2 Sui WG,Yan Q,Xie SP,et al.Successful organ donation from brain dead donors in a Chinese organ transplantation center.AmJ Transplant,2011,11(10):2247-2249.
3 Chen GD,Shui-Chung KOD,Wang CX,et al.kedney transplantation from donors after cardiac death:an initial report of 71 cases from China.Am J Transplant,2013,13(5):1323-1326.
4 傅茜,王长希,李军,袁小鹏,邓荣海,陈立中,费继光,邱江,邓素雄.公民逝世后器官捐献肾移植单中心233例临床效果分析.中华泌尿外科杂志,2014,35(1):15-19.
5 郑树森,徐骁,庄莉,屠振华,李建辉.中国心脏死亡捐献器官评估与应用专家共识.中华移植杂志(电子版),2014,8(03):117-122.
6 Nagaraja P,Roberts GW,Stephens M,et al.Influence of delayed graft function and acute rejection on outcomes after kidney transplantation from donors after cardiac death.Transplantation,2012,94(12):1218-1223.
7 de Vries EE,Hoogland PE,Wind J,et al.Transplantation of kidneys from paediatric DCD donors:a comparison with DBD donors.Nephrol Dial Transplant,2013,28(1):220-226.
8 Randhawa P.Role of donor kidney biopsies in renal transplantation.Transplantation,2001,71(10):1361-1365.
9 郭晖,陈知水,陈实.公民逝世后器官捐献供肾的病理学评估.器官移植,2018,9(01):1-8.
10 尤冰,李平,焦晨峰,等.心脏死亡器官捐献供肾零点活检慢性病变的预测价值.肾脏病与透析肾移植杂志,2018,27(4):320-325.
11 张朋朋,明英姿,叶啟发.肾移植术后重症肺部感染患者死亡危险因素分析.中华移植杂志(电子版),2016,10(2):66-70.
2 Sui WG,Yan Q,Xie SP,et al.Successful organ donation from brain dead donors in a Chinese organ transplantation center.AmJ Transplant,2011,11(10):2247-2249.
3 Chen GD,Shui-Chung KOD,Wang CX,et al.kedney transplantation from donors after cardiac death:an initial report of 71 cases from China.Am J Transplant,2013,13(5):1323-1326.
4 傅茜,王长希,李军,袁小鹏,邓荣海,陈立中,费继光,邱江,邓素雄.公民逝世后器官捐献肾移植单中心233例临床效果分析.中华泌尿外科杂志,2014,35(1):15-19.
5 郑树森,徐骁,庄莉,屠振华,李建辉.中国心脏死亡捐献器官评估与应用专家共识.中华移植杂志(电子版),2014,8(03):117-122.
6 Nagaraja P,Roberts GW,Stephens M,et al.Influence of delayed graft function and acute rejection on outcomes after kidney transplantation from donors after cardiac death.Transplantation,2012,94(12):1218-1223.
7 de Vries EE,Hoogland PE,Wind J,et al.Transplantation of kidneys from paediatric DCD donors:a comparison with DBD donors.Nephrol Dial Transplant,2013,28(1):220-226.
8 Randhawa P.Role of donor kidney biopsies in renal transplantation.Transplantation,2001,71(10):1361-1365.
9 郭晖,陈知水,陈实.公民逝世后器官捐献供肾的病理学评估.器官移植,2018,9(01):1-8.
10 尤冰,李平,焦晨峰,等.心脏死亡器官捐献供肾零点活检慢性病变的预测价值.肾脏病与透析肾移植杂志,2018,27(4):320-325.
11 张朋朋,明英姿,叶啟发.肾移植术后重症肺部感染患者死亡危险因素分析.中华移植杂志(电子版),2016,10(2):66-70.