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目的:比较分析心脏死亡器官捐献(DCD)供肾移植中扩大标准供肾(ECD)和标准供肾(SCD)的早期临床效果。方法:回顾性分析2015年1月~2016年4月在我科完成的109例DCD供肾肾移植,其中ECD组36例,SCD组73例。所有供肾均采用单纯低温静态保存。所有患者均采用抗体诱导+他克莫司(FK506)+吗替麦考酚酯(MMF)+泼尼松(Pred)四联免疫抑制方案。分析评价2组患者术后1个月内肺部感染发生率、急性排斥反应发生率、移植肾功能延迟恢复(DGF)发生率以及肾功能恢复情况。结果:ECD组DGF发生率为38.2%,SCD组为20.0%,差异有统计学意义(P<0.05);ECD组急性排斥反应发生率为20.6%,SCD组为4%,差异有统计学意义(P<0.05);ECD组肺部感染发生率为5.8%,SCD组为6.1%,差异无统计学意义(P>0.05);术前、术后1、3、7、14、21、30天血肌酐值,ECD组要高于SCD组(P<0.05)。结论:ECD组术后DGF发生率较SCD组高,急性排斥反应发生率较SCD组明显增加,但是两组肺部感染发生率并无明显差异。SCD组肾功能恢复趋势要明显优于ECD组。
Objective: To compare and analyze the early clinical effect of extended standard donor kidney (ECD) and standard donor kidney (SCD) in donor kidney donation (DCD). Methods: A total of 109 DCD recipients in our department from January 2015 to April 2016 were retrospectively analyzed. Among them, 36 were in the ECD group and 73 in the SCD group. All kidneys are used at low temperature static preservation. All patients received antibody-induced + tacrolimus (FK506) + mycophenolate mofetil (MMF) plus prednisolone (Pred) quadruple immunosuppression regimen. The incidence of pulmonary infection, incidence of acute rejection, delayed graft function (DGF) and renal function recovery within 1 month after operation were analyzed and evaluated. Results: The incidence of DGF in ECD group was 38.2% and in SCD group was 20.0%, the difference was statistically significant (P <0.05). The incidence of acute rejection in ECD group was 20.6% and in SCD group was 4%, the difference was statistically significant (P <0.05). The incidence of pulmonary infection was 5.8% in ECD group and 6.1% in SCD group, with no significant difference (P> 0.05). Preoperative and postoperative 1,3,7,14,21,30 The serum creatinine value in ECD group was higher than that in SCD group (P <0.05). Conclusion: The incidence of postoperative DGF in ECD group is higher than that in SCD group, and the incidence of acute rejection is significantly higher than that in SCD group. However, the incidence of pulmonary infection in the two groups has no significant difference. Renal function recovery trend in SCD group was significantly better than ECD group.