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目的:亲属间活体肾移植治疗肾功能衰竭。方法:36例志愿手术者中,直系血缘亲属(母子)2例;姊妹兄弟3例;夫妻1例;旁系三代以内血缘亲属30例。HLA全配1例,HLA单倍体相同29例,HLA有5个抗原错配者4例,HLA完全错配者2例。经气管插管麻醉下手术切取一侧肾脏,7例取供者右肾,29例取左肾,同期实施同种异体肾移植术。受者术后采用环孢素A、硫唑嘌呤(或霉酚酸酯)及泼尼松预防排斥反应。结果:所有供者术后15天内出院,随访21-1个月,血压及肌酐尿素氮正常,留存肾多谱勒血流指数正常。所有受者未出现急性排斥反应及严重感染性并发症,术后2例发生尿瘘,1例经手术治疗痊愈。1例术后6月发生移植肾输尿管坏死狭窄,经手术治疗痊愈。1例术后22天发生移植肾动脉血栓栓塞,急诊手术取栓,因栓塞范围超过移植肾80%,不得已切除植肾。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;与同期尸肾移植比较,亲属活体肾移植的组织配型明确,供肾缺血时间短,排斥反应发生少,免疫抑制剂用量小,移植肾预期存活率高。
Objective: Relative living donor kidney transplantation for renal failure. Methods: Of the 36 volunteers, 2 were blood relatives (mother and child), 3 were siblings, 1 was husband and wife and 30 were blood relatives within three generations. One matched HLA, 29 HLA identical haplotypes, 4 HLA mismatches with 5 antigens and 2 HLA mismatches. Transanal intubation anesthesia surgery to remove the side of the kidney, 7 cases of donor right kidney, 29 cases of left kidney, the same period of allogeneic kidney transplantation. Recipients were treated with cyclosporine A, azathioprine (or mycophenolate) and prednisone to prevent rejection. Results: All donors were discharged within 15 days after operation and were followed up for 21 to 1 month. Blood pressure and creatinine and urea nitrogen were normal, and renal Doppler flow index was normal. All recipients did not appear acute rejection and severe infectious complications, 2 cases of urinary fistula occurred after operation, and 1 case was cured by surgery. A case of renal graft stenosis occurred in 6 months after operation and healed by surgery. One patient developed graft-versus-renal artery thromboembolism 22 days after operation. Emergency surgery was performed to take the suppository. Because the embolization range exceeded 80% of the allograft, it had no choice but to remove the kidneys. CONCLUSION: A comprehensive and comprehensive evaluation of donors and recipients before surgery is a guarantee of success of living donor kidney transplantation. Compared with cadaveric kidney transplantation in the same period, the tissue distribution of relative living kidney transplantation is clear, the time for renal ischemia is short, and the incidence of rejection is small , A small amount of immunosuppressive agents, graft survival is expected to high.