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目的探讨DCD捐献肾脏移植的经验及免疫诱导的临床效果观察。方法分析本院于2011年12月至2013年12月完成的40例DCD捐献肾移植患者的临床资料,根据免疫诱导药物的不同,分为舒莱组(10例)、ATG组(15例)和ATG-F组(15例)。结果 40例患者中除3例出现DGF外,其余患者术后血肌酐均平稳下降,恢复正常;3组患者中均有1例发生DGF,ATG组发生急排1例,其余组无急排发生;所有组均无原发肾无功能发生;CMV发生率:舒莱组4例(40%),ATG组10例(71%),ATG-F组11例(73%);ATG组发生肺部感染1例,其余组均无肺炎发生;ATG、ATG-F组分别有5、6例出现血小板及血红蛋白下降,无其他不良反应;除ATG组肺炎患者死亡外,其余均带功存活;术后恢复正常的肾脏病理表现为肾小球及肾小管结构清晰,而DGF的活检病理表现为肾小管肿胀,部分肾小管变性坏死。结论 DCD是解决我国器官移植界瓶颈的重要手段,中国三类(DBCD)是较理想的DCD供者。免疫诱导能够有效预防急性排斥的发生,但可引起机体广泛抑制,导致潜伏的CMV复活;取肾过程中尽量缩短热缺血时间,DGF发生率较低。供肾零点活检应该成为DCD供肾肾脏移植的常规检查项目,但慎重决定取舍。
Objective To investigate the experience of DCD donor kidney transplantation and the clinical effect of immune induction. Methods The clinical data of 40 patients with DCD donated by our hospital from December 2011 to December 2013 were analyzed. According to the different immunosuppressive drugs, they were divided into the Shure group (10 cases), the ATG group (15 cases) And ATG-F group (15 cases). Results The serum creatinine of the remaining 40 patients showed a steady decline and returned to normal except for 3 cases of DGF in 40 cases. DGF was found in 1 of the 3 groups and in 1 case of ATG ; The incidence of CMV in 4 cases (40%) in Schure group, 10 cases (71%) in ATG group and 11 cases (73%) in ATG-F group; The incidence of CMV In 1 case of ATG and ATG-F, there were 5 and 6 cases of platelet and hemoglobin decreased, no other adverse reactions were observed. After the return of normal pathological renal glomeruli and tubular manifestations of clear, and DGF biopsy showed tubule swelling, part of the renal tubular degeneration and necrosis. Conclusion DCD is an important means to solve the bottleneck of organ transplantation in China. Three types of China (DBCD) are the ideal DCD donors. Immune induction can effectively prevent the occurrence of acute rejection, but can cause extensive inhibition of the body, resulting in the revival of latent CMV; take the kidney as shortening the time of warm ischemia, DGF lower incidence. Zero-point biopsy of kidneys should become a routine checkup for DCD for renal allografts, but choose carefully.