Short-term effect evaluation of kidney transplantation from the extended criteria donors of the donation after cardiac death
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摘要: 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。Abstract: Objective:To compare early results in kidney transplantation between extended criteria donors (ECD) of the donation after cardiac death (DCD) and standard criteria donors (SCD) of the DCD.Method:From January 2015 to April 2016,109 recipients of kidney transplantation from DCD in our department were retrospectively analyzed.There were 36 cases receiving from ECD and 73 from SCD.Kidneys were all using pure static preserved at low temperature.All recipients were performed using quadruple immunosuppression with antibody induction and tacrolimus (FK506) and mycophenolate mofetil (MMF) plus prednisone (Pred).We compared the patient and graft survival,the incidence of pulmonary infection,acute rejection and delayed graft function (DGF) between two groups.We also analyzed the patients' postoperative renal function.Result:The incidence rate of DGF in the ECD group and SCD group were 38.2% and 20.0% respectively,which showed significant statistical difference (P<0.05).The rate of acute rejection was 20.6%in group ECD,and 4%in group SCD.Also there existed significant statistical difference (P<0.05).However,there was no significant difference (P>0.05) in the rate of pulmonary infection between two groups (5.8%in group ECD,6.1%in group SCD).Preoperative serum creatinine (SCr) level and the postoperative 1st,3rd,7th,14 th,21st,30 th day level were obviously higher in the ECD group than those in the SCD group (P<0.05).Conclusion:The incidence rate of DGF and acute rejection in the ECD group is higher than those in the SCD group,but no difference can be found between the two groups in the incidence of pulmonary infection.SCr falling speed of group SCD is faster than that of group ECD.
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