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目的探讨儿童逝世后器官捐献供肾双肾整块肾移植的临床效果。方法回顾性分析9例儿童供肾双肾移植供、受者临床资料。计算受者的1年人、肾存活率,观察术后1年受者肾功能恢复情况,移植肾长度变化及术后不良事件发生情况。结果 9例受者术后1年的人、肾存活率分别为8/9、72%。随访1年,血清肌酐(Scr)水平由术前(747±170)μmol/L下降至(83±27)μmol/L,血尿素氮由术前(24.5±4.9)mmol/L下降至(6.8±2.0)mmol/L,移植肾长度由术前(61.1±9.8)mm增长至(100.3±1.7)mm。术后发生移植物功能延迟恢复(DGF)2例,行血液透析过渡后恢复移植肾功能;发生急性排斥反应2例,予甲泼尼龙冲击治疗后逆转;1例于术后2周发生肺部真菌感染,停用免疫抑制剂,予抗真菌治疗,但效果不佳,于术后3个月死亡;1例术后7 d发生移植肾动脉血栓形成,术后10 d行移植肾切除术,恢复血液透析;1例术后1个月发生1个移植肾动脉栓塞,剩余移植肾功能正常,术后6个月生长明显。此外,发生移植肾输尿管狭窄2例、蛋白尿2例、腹主动脉狭窄1例、尿瘘1例,经相应处理后均治愈或好转。结论儿童逝世后器官捐献供肾双肾整块肾移植围手术期并发症较多,但随着经验逐步积累,儿童双供肾肾移植的移植效果在逐步改善。
Objective To investigate the clinical effect of kidney donor kidney transplantation after organ donation. Methods Retrospective analysis of 9 cases of children with kidney transplantation for renal transplant recipients clinical data. The recipients’ 1-year survival rate of kidney and kidney were observed. The recovery of renal function, the length of graft kidney and the incidence of postoperative adverse events were observed. Results Nine patients received one year postoperatively, and the renal survival rates were 8/9 and 72% respectively. After one year of follow-up, serum creatinine decreased from (747 ± 170) μmol / L to (83 ± 27) μmol / L preoperatively and blood urea nitrogen decreased from (24.5 ± 4.9) mmol / ± 2.0) mmol / L, and the length of transplanted kidney increased from (61.1 ± 9.8) mm to (100.3 ± 1.7) mm preoperatively. Two cases of postoperative delayed graft function (DGF) were recovered, and graft function was restored after hemodialysis transition. Two cases of acute rejection occurred after treatment with methylprednisolone and one case of pulmonary injury occurred 2 weeks after operation Fungal infections, immunosuppressive drugs, antifungal therapy, but the effect is not good, died at 3 months after surgery; 1 case occurred 7 days after transplantation of renal artery thrombosis, 10 days after transplantation for nephrectomy, Hemodialysis was resumed. One patient had a transplanted renal artery embolization one month after operation and the remaining graft function was normal. The growth was obvious at 6 months after operation. In addition, 2 cases of transplanted renal ureteral stricture, proteinuria in 2 cases, abdominal aortic stenosis in 1 case, urinary fistula in 1 case, after the corresponding treatment were cured or improved. Conclusions There are more perioperative complications of kidney donor kidney transplantation after organ donation. However, with the gradual accumulation of experience, the transplantation effect of double donor kidney transplantation is gradually improving.