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背景:研究表明,心脏死亡器官捐献供肾受者的维持肌酐水平较高,心脏死亡器官捐献供肾其移植肾功能延迟恢复发生率也较高。目的:分析有机磷中毒心脏死亡器官捐献供肾肾移植的临床效果。方法:将有机磷中毒的2例捐献供者,给予相应维护,器官获取后,供肾使用脉冲式机器灌注,受者肾移植过程中、移植后给予免疫诱导、抗排斥、预防感染等治疗。收集供肾相关实验室检查以及零点穿刺病理资料,分析受者的肾移植后移植肾功能恢复情况、受者及移植物生存情况、并发症(移植肾功能延迟恢复与急性排斥反应)的发生率。结果与结论:(1)4个供肾穿刺病理发现:所有供肾肾小球形态基本正常,肾小管均有不同程度的水肿、变性;(2)受者肾移植后急性排斥反应:4例发生率为0(0/4),移植肾功能延迟恢复发生率为75%(3/4),围手术期受者存活率及移植肾存活率均为100%(4/4);(3)所有受者出院时及出院后相关生物指标:肌酐、尿素氮均维持较低水平,移植肾功能良好,均未出现蛋白尿。有1例受者术后4个月因重症肺部感染带肾死亡;(4)结果提示:对于部分达到待捐状态的有机磷中毒供者,给予相关器官功能维护措施及使用机器灌注改善保存供肾方式,能有效改善器官捐献供肾的保存质量,移植后患者恢复良好。在目前器官来源严重匮乏情况下,重度有机磷中毒导致到达待捐献状态的患者在经系列器官功能维护后,一定条件下可以作为一种新的器官来源。
Background: Studies have shown that cardiac death organ donation for renal recipients maintains a high level of creatinine, and cardiac death organ donor kidney donation also has a higher incidence of delayed graft function recovery. OBJECTIVE: To analyze the clinical effect of organ donor donated by organophosphate poisoning on kidney transplantation. Methods: Two cases of organophosphate poisoning were donated to donors for corresponding maintenance. After organs were obtained, the kidneys were perfused by pulse machine. During kidney transplantation, immune induction, anti-rejection and infection prevention were given after transplantation. Collecting renal-related laboratory tests and pathological data of zero-point puncture to analyze the recipient’s renal graft recovery after kidney transplantation, the survival of recipients and grafts, complication (delayed graft recovery and acute rejection) . RESULTS AND CONCLUSION: (1) Four pathological findings of renal biopsy revealed that all kidney glomeruli were normal and all tubules had different degree of edema and degeneration. (2) Acute rejection after kidney transplantation in recipients: 4 cases (0/4). The delayed graft recovery rate was 75% (3/4). The perioperative survival rate and graft survival rate were 100% (4/4) ) All of the recipients were discharged and discharged after the relevant biological indicators: creatinine, urea nitrogen were maintained at a low level, good graft function, did not appear proteinuria. (4) The results suggest that for organophosphate poisoning donors who are partly donated, the related organ function maintenance measures should be given and the use of machine perfusion to improve the preservation Kidney, can effectively improve the quality of organ donation for the preservation of the kidney, the patient recovered well after transplantation. Severe organophosphate poisoning causes severe organophosphorus poisoning in patients who are currently on their way to donate as a new organ source under certain conditions after maintenance of a series of organ functions.