器官移植2017，Vol.8Issue(6)：424-429,6.DOI:10.3969/j.issn.1674-7445.2017.06.003
伴急性肾损伤的脑死亡器官捐献供者供肾移植治疗的体会
Experience of clinical efficacy of renal transplantation from donors of donation after brain death complicated with acute kidney injury
摘要
Abstract
Objective To summarize the clinical efficacy of renal transplantation from donors of donation after brain death (DBD) complicated with acute kidney injury (AKI). Methods Fifty-nine DBD donors successfully undergoing renal transplantation were recruited in this investigation. According to the Scr level upon admission of intensive care unit (ICU), DBD donors were divided into the AKI group (n=14) and control group (n=45). A total of 101 recipients were assigned into the AKI group (n=23) and control group (n=78) correspondingly. The organ donation conditions of 59 donors were summarized. Main parameters of the donors before organ procurement were statistically compared between two groups. Postoperative kidney function, hospitalization condition and clinical outcomes of the recipients were statistically compared between two groups. Results Among 59 donors, 14 cases (24%) suffered from AKI. Two donors received continuous renal replacement therapy during organ maintenance. Compared with the donors in the control group, the APACHE Ⅱ score of the donors was significantly higher (P<0.05), the incidence of central diabetes insipidus was considerably higher (P<0.01), the Scr levels at admission of ICU and before organ procurement were significantly higher (both P<0.01) and the amount of urine at 24 h before organ procurement was dramatically less in the AKI group (P<0.01).Compared with the recipients in the control group, the Scr levels at postoperative 2 and 3 d were significantly higher (both P<0.05), the length of hospital stay was considerably longer (P<0.01) and the hospitalization expanse was significantly higher in the AKI group (P<0.05). No statistical significance was observed in the postoperative delayed recovery of renal graft function, incidence of acute rejection, infection and rehabilitation dialysis in the recipients between two groups (all P>0.05). At 3 months after transplantation, the recipients in two groups were discharged and the graft survival rate was 100%. Conclusions For renal transplantation from DBD donors complicated with AKI, active measures should be taken to maintain the organ and relieve the AKI, which yields similar clinical efficacy to renal transplantation from non-AKI donors and widens the origin of kidney graft.关键词
急性肾损伤/脑死亡器官捐献/肾移植/边缘供体/器官维护/急性排斥反应/移植肾功能延迟恢复/持续性肾脏替代治疗Key words
Acute kidney injury/Donation after brain death/Renal transplantation/Marginal donor/Organ maintenance/Acute rejection/Delayed recovery of renal graft function/Continuous renal replacement therapy分类
医药卫生引用本文复制引用
王红宇,焦宪法,牛杏果,董慧君,梁韶峰,曲青山..伴急性肾损伤的脑死亡器官捐献供者供肾移植治疗的体会[J].器官移植,2017,8(6):424-429,6.基金项目
河南省医学科技攻关计划项目(201303229) （201303229）
