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目的总结分析112例亲属活体肾移植的经验。方法回顾性分析112例已完成的活体亲属供肾肾移植患者的临床资料,11例为夫妻间供肾,其余为血缘亲属供肾;交叉反应组(CREGs)误配率为3MM(missmatch)、2MM、1MM、0MM的移植例数分别为74,11,4,23;112例均为开放手术取肾,32例取供者右肾,80例取左肾;受者均为第一次接受肾移植手术,术后采用环孢素A(或他克莫司)、霉酚酸酯及泼尼松三联抗排斥反应治疗。结果所有供者手术顺利,术后7~12天出院,平均9.5天。随访至今,肾功能均正常。所有受者均安全度过围手术期。术后1例发生髂外动脉夹层动脉瘤,1例发生移植肾输尿管梗阻,1例发生淋巴囊肿,均经手术治愈。11例发生急性排斥反应,经抗胸腺细胞球蛋白(ATG)冲击治疗,均逆转。随访2~48个月,人/肾存活率100%/100%。结论术前对供、受者进行全面综合评估是亲属活体肾移植成功的保证;亲属活体肾移植等待时间短,组织配型好,供肾缺血时间短,排斥反应发生少,移植肾存活率高,是一种安全可行的治疗手段。
Objective To summarize and analyze the experience of 112 cases of living donor kidney transplantation. Methods A retrospective analysis was performed on the clinical data of 112 cases of living-related kidney transplant recipients. Eleven cases were donor spouses and the rest were relatives. The mismatch rate of cross-reactive group (CRMs) was 3MM (missmatch) 2MM, 1MM, 0MM transplant cases were 74,11,4,23; 112 cases were open surgery to take the kidney, 32 cases of donor right kidney, 80 cases of left kidney; the recipients were the first to accept Kidney transplant surgery, postoperative use of cyclosporine A (or tacrolimus), mycophenolate mofetil and prednisone triple anti-rejection therapy. Results All donors operated smoothly and were discharged from 7 to 12 days after operation, an average of 9.5 days. Follow-up so far, renal function are normal. All recipients were safely peri-operative. One case had an external iliac artery dissection aneurysm, one case had ureteral obstruction of graft and one case had lymphatic cyst. All of them were surgically cured. Eleven cases of acute rejection occurred after anti-thymocyte globulin (ATG) shock treatment, were reversed. Follow-up 2-48 months, human / kidney survival rate of 100% / 100%. Conclusion Preoperative comprehensive evaluation of donors and recipients is a guarantee of success of living donor kidney transplantation. The relative waiting time of living donor kidney transplantation is short, the tissue configuration is good, the duration of renal ischemia is short, rejection is rare, and graft survival rate High, is a safe and feasible treatment.