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目的总结亲属活体供肾移植的临床经验。方法 41例供者均经开放手术取肾,33例取供者左肾,8例取供者右肾。41例受者手术同尸体肾移植,术后采用环孢素A(或他克莫司)、硫唑嘌呤(或霉酚酸酯)及泼尼松预防排斥反应。结果 41例受者均手术顺利,39例肾功能在2～5d恢复正常,2例术中行二次灌注发生延迟肾功能恢复。随访期间存活40例,30例肾功能正常,9例血肌酐稍高,1例术后2年自行停药导致肾衰竭,重新恢复血透治疗。死亡1例,原因为术后2年发生肺部真菌及巨细胞病毒混合感染。急性排异反应1例,经激素冲击后逆转。5例男性受者已结婚生育。41例供者术后均恢复顺利,平均住院时间10d。随访期间肾功能均正常,尿蛋白阴性。结论亲属活体肾移植具有组织配型好、供肾缺血时间短及排异反应少等优点,其效果优于尸体供肾移植。术前对供、受者进行全面综合评估是保证亲属活体肾移植成功的关键。
Objective To summarize the clinical experience of living donor kidney transplantation. Methods Totally 41 donors were enrolled in this study. Left kidney was obtained from 33 cases and left kidney was obtained from 8 cases. Forty-one patients underwent the same operation as the autologous kidney transplantation. After the operation, cyclosporine A (or tacrolimus), azathioprine (or mycophenolate) and prednisone were used to prevent rejection. Results All the 41 cases were operated smoothly. Renal function in 39 cases returned to normal after 2 ~ 5 days. Delayed renal function recovery occurred in 2 cases after secondary perfusion. Survival during follow-up of 40 cases, 30 cases of normal renal function, 9 cases of serum creatinine slightly higher, 1 case 2 years after their own withdrawal lead to renal failure, to restore hemodialysis treatment. 1 patient died of pulmonary fungal and cytomegalovirus infections after 2 years. Acute rejection reaction in 1 case, reversed by hormone shock. Five male recipients have been married. All 41 donors recovered smoothly after operation, with an average hospital stay of 10 days. Renal function was normal during follow-up, and urinary protein was negative. Conclusion Relatives living donor kidney transplantation has the advantages of good tissue matching, shortened renal ischemia time and fewer rejection reactions, which is superior to cadaver donor kidney transplantation. Preoperative donor and recipient comprehensive comprehensive assessment is to ensure the success of living relatives kidney transplantation key.