亲属活体供肾来源对肾移植疗效影响的临床观察

摘要

Objective To analyze the impact of allograft category on the result of living related donor kidney transplantation (LRKT)and to evaluate the predominant donors. Methods A retrospective analysis of 104 recipients receiving LRKT from Apr. 2004 to Mar. 2008 was performed. Based on donor resource, all the recipient-donor pairs were divided into four groups: spousal donation group,parental donation group, sibling donation group and cousinly donation group. The observational parameters were selected for analysis, such as average post-transplant hospitalization dates, time for serum creatinine (Scr) back to normal level, Scr levels of every observational time point, incidence of major complications (infection, rejection, DGF) and recipient/graft survival rate. Results Recipient/graft survival rate of sibling donation group seemed higher. Recipients of sibling donation group seemed to have fewer post-transplant hospitalization dates, but higher rates of infection, while those of parental donation group seemed to have higher rates of rejection. Rates of rejection and infection of spousal donation group were lower than supposed. There was no statistically significant difference in time for Scr back to normal level and Set levels of every observational time point among these four groups. Conclusions The result of sibling donor renal transplantation is better, while short-term outcome of spouse donor renal transplantation is ideal, which is similar with parent or cousin donor renal transplantation. Except for human leukocyte antigen, aspects such as quality of donor kidney, predominance during operation and self-administration post-transplant are also the guarantee for the success.%目的 观察亲属活体供肾来源对肾移植临床疗效的影响,并探讨可能的优势供体.方法 回顾分析我院自2004年4月至2008年3月完成的104例亲属活体供肾移植的临床资料,按供肾来源分为夫妻间供肾组(10例)、父母供肾组(59例)、兄弟姐妹间供肾组(25例)和表兄弟姐妹间供肾组(10例),通过观察各组的术后平均住院天数、血肌酐恢复正常时间、各时间点血肌酐水平、主要并发症(感染、排斥、DGF等)发生率及人/肾存活情况等指标,比较分析各组的临床疗效.结果 随访1～48月,兄弟姐妹间供肾组无受者死亡或移植物丢失,而夫妻供肾组、父母供肾组和表兄弟姐妹供肾组受者死亡例数分别为1例、2例和1例,移植物丢失例数分别为1例、3例和1例.兄弟姐妹间供肾组受者术后平均住院天数为(13.72±4.15)d,有较其他组短的趋势,但有较高的感染发生趋势(20%).夫妻间供肾组显示了较低的感染(0%)和排斥(10%)发生趋势.父母供肾组的排斥发生率(18.64%)高于其他组(P<0.05).血肌酐恢复正常时间和各时间点血肌酐水平在各组间无统计学差异.结论 兄弟姐妹间供肾移植疗效相对较佳,无血缘关系的夫妻间供肾移植亦具有较理想的疗效,短期的人/肾存活情况类似于父母和表兄弟姐妹供肾移植.良好的肾移植疗效不能简单地归因于组织配型(血缘关系),供肾质量、手术优势及术后管理可能也是重要因素.