Clinical investigation of kidney transplantation from cardiopulmonary resuscitation donors of cardiac death
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摘要: 目的:探讨有心肺复苏史供者心脏死亡器官捐献(DCD)供肾肾移植围手术期诊疗方法及短期临床疗效。方法:回顾性分析2011年12月~2015年11月西安交通大学第一附属医院肾移植科完成的34例器官捐献前有心肺复苏史的供者,供给59例肾移植受者的供、受者临床资料,分析心肺复苏对DCD肾移植受者预后的影响。结果:有心肺复苏史DCD供肾肾移植受者术后短期内并发症发生率较高,早期人/肾存活率为84.74%,较无心肺复苏史DCD供者稍低但差异无统计学意义,长期人/肾存活率尚需进一步随访和观察。结论:①有心肺复苏史DCD供肾作为边缘性供肾,对器官短缺的现状是一种很好的补充;②供者纳入标准:＜10min的心肺复苏、供者肾功正常,捐献器官可直接用于移植;10~30min的心肺复苏供者,需要严格观察血压、肾功能、尿量的综合变化,评估风险后考虑是否移植;心肺复苏＞30min的供者尽量避免移植;③做好供体原发病全面准确评估和有效维护好器官功能,尤其加强Lifeport的应用及重视潜在感染供者(培养结果),并动态观察心肺复苏后尿量和肾功能的变化以及供体器官获取前激素、肝素、尿激酶的应用非常重要。
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关键词:
- 心肺复苏 /
- 心脏死亡器官捐献供肾 /
- 肾脏移植 /
- 早期临床疗效
Abstract: Objective:To investigate perioperative treatment method and the early clinical effect of kidney transplantation from cardiopulmonary resuscitation (CPR) of donation after cardiac death (DCD).Method:A retrospective review of clinical data of 34 donors and 59 recipients from CPR of DCD from December 2011 to November 2015 in our department was done.The effect of CPR on the prognosis of DCD renal transplant recipients was analyzed.Result:Following the DCD organ donation standard and the supervision and appraisal by our hospital ethics committee,various surgical operations were implemented in the study.Perioperative treatment and nursing measures followed the international and domestic standards,combining our center clinical experience of many years.Early survival rate of human with kidney was 84.74%,which was lower than that of DCD without CPR.Conclusion:①DCD from CPR donation is an effective supplement to kidney source shortage.②Our center adheres to the following principles:If the time of CPR was less than 10 minutes and renal function was normal,we will implement organ donation directly;If the time of CPR was 10-30 minutes,we will assess blood pressure,kidney function and urine volume comprehensively and discuss the risk of operation;If the time of CPR was more than 30 minutes,we suggest giving up donating.③In addition,repair and maintenance of the donors of the primary diseases and organs function are very important,especially potential infectious donors.Observing the change of the urine and kidney function dynamically,application of hormone,heparin and urokinase before organ procurement,application of Lifepot,anti-infection and postoperative follow-up are all keys to assure outcomes of kidney transplantation. -
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