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目的探讨西北初期开展心脏死亡器官捐献(DCD)肾脏移植的效果及应对术后移植肾功能延迟恢复(DGF)的措施。方法选自2011~2013年我院开展的DCD肾脏移植资料及术后随访记录,期间共有51例DCD供者家庭在ROC协调下知情并签字同意器官捐献,通过OPO组织成功获取102只肾脏,实施了94例肾脏移植。术后根据是否发生DGF分为两组:DGF组和无DGF组,并加以比较。结果 DCD器官捐献的成功率是29.3%,DCD肾脏移植术后DGF发生率为27.7%,术后1年的人/肾成活率为98.9%/95.7%。术后半年内DGF组eGFR值显著低于无DGF组,血清肌酐值显著高于无DGF组(P<0.05),移植半年后两组间无显著性差异(P<0.05)。DGF发生率在应用LifePort低温机械灌注法保存的DCD供肾(21.5%)明显低于采用单纯低温冷保存的供肾(41.4%,P<0.05)。结论尽管DCD肾脏移植术后DGF发生率偏高,但总体效果良好,推荐使用低温机械灌注法用于DCD供肾的存储运输。
Objective To investigate the effect of early kidney transplantation (DON) on cardiac death organ donation (DCD) in northwestern China and the measures of postoperative delayed graft function (DGF). METHODS: Data of DCD kidney transplantation and postoperative follow-up were collected from 2011 to 2013 in our hospital. During this period, a total of 51 DCD donor families were informed and signed the consent organ donation coordinated by ROC. 102 kidneys were successfully obtained through OPO 94 cases of kidney transplantation. Postoperative DGF was divided into two groups based on whether or not DGF group and no DGF group, and compared. Results The success rate of DCD organ donation was 29.3%. The incidence of DGF after DCD kidney transplantation was 27.7%. The survival rate of human / kidney after one year was 98.9% / 95.7%. After 6 months, the eGFR in DGF group was significantly lower than that in non-DGF group, serum creatinine was significantly higher than that in non-DGF group (P <0.05). There was no significant difference between the two groups after six months of transplantation (P <0.05). DGF incidence was significantly lower in DCD donor kidneys (21.5%) than in hypothermic cold recipients (41.4%, P <0.05) when preserved with LifePort cryogenic mechanical perfusion. Conclusion Although the incidence of DGF after kidney transplantation in DCD is high, the overall effect is good. It is recommended to use low-temperature mechanical perfusion for storage and transportation of DCD kidneys.